Paratricipital two window approach for complex intraarticular distal humerus fractures: A prospective analysis of 27 patients

BACKGROUND: To investigate the utility and complications of paratricipital 2 window approach for complex intra articular distal humerus fractures (AO/OTA type C). METHODS: Between December 2012 and September 2016 , 27 patients (male-14, female-13) having mean age of 39 years (range, 22–62 years) with closed intra articular fracture (AO/OTA 13 type C) were surgically managed using paratricipital 2 window approach. Fractures were fixed as per AO principles. All patients were followed up for 21 months (range, 12–28 months) prospectively. Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Student t-test, Pearson co-relation coefficient and Kruskal Wallis test used for statistical evaluation. RESULT: All cases unite by the end of 3 months. Mean flexion achieved was 120° and extension lag was 10°. Mean arc of motion was 111°. Mean pronation and supination was 70° and 77° respectively. MEPS and motion arc were weak negatively co- related with surgical delay and advancement in age. Post-operative transient ulnar nerve palsy and heterotrophic ossification (HO) was noted in 3.7% cases and infection occurred in 7.4% cases. Hardware prominence noted in 11.1% cases. Mean MEPS was 82. MEPS was excellent in 18.5%, good in 62.9%, fair in 11.1% and poor in 7.4% cases. CONCLUSION: Paratricipital 2 window approach for these fractures had good functional outcome with fewer complications. We advocate paratricipital 2 window approach when dealing with these complex fractures particularly, in type C1 and type C2.