title: Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture.
abstract: OBJECTIVE
  To assess the outcomes of the lateral para-olecranon triceps-splitting approach for the treatment of distal humeral fracture.
  
  
  METHODS
  Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification. Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy approach was indicated to visualize the anterior fragment. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. The lateral half of the triceps along with anconeus was retracted laterally as a single unit. The distal part of the humerus could be visualized from medial and lateral windows by retracting the medial half of the triceps. The articular fragment was anatomically reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal articular block was then fixed to the humeral shaft with double locking plates.
  
  
  RESULTS
  After surgery, average elbow flexion was 127° (range, 110°-145°), and extension was -10° (range, -20°-0°) at the average follow-up time of 12.4 months (range, 8‒20 months). Seven patients had normal muscle strength against full resistance (manual muscle testing grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4). No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There were no cases of triceps insufficiency and nonunion. The average (± SD) Mayo Elbow Score was 93.5 ± 5.8 points at the final follow-up.
  
  
  CONCLUSIONS
  The lateral para-olecranon approach is useful for the management of selected fractures of the distal humerus, preserving extension strength and providing satisfactory clinical outcomes, with no risk of olecranon osteotomy-related complications.
  
  
  METHODS
  Therapeutic V.
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. Electronic address: iwatakuji@gmail.com.
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwamoto
authors.affiliation: Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Matsumura
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D056740:Olecranon Process; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Distal humeral fracture; olecranon osteotomy; surgical approach; triceps-splitting