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Medial versus Posterior Triceps Splitting Approach in Open Reduction Internal Fixation of Displaced Supracondylar
Poojan K Rokaya1, Dhan Bahadur Karki1, Mangal Rawal1
1Department of Orthopedics and Trauma Surgery, Karnali Academy of Health Sciences, Jumla, Nepal.
Insights
The medial approach offers superior functional outcomes for pediatric humerus fractures compared to the posterior triceps splitting approach. Radiological results were similar, but the medial approach minimized loss of range of motion.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Fracture Management
Background:
- Displaced supracondylar humerus fractures are common in children.
- Surgical intervention is often required for optimal bone healing and function.
- Choosing the appropriate surgical approach is critical for patient outcomes.
Purpose of the Study:
- To compare the clinical and radiological outcomes of medial versus posterior triceps splitting approaches.
- To evaluate functional and cosmetic results following open reduction internal fixation.
- To determine the optimal surgical strategy for pediatric supracondylar humerus fractures.
Main Methods:
- Retrospective review of 70 pediatric patients with displaced supracondylar humerus fractures.
- Comparison of medial approach (n=30) and posterior triceps splitting approach (n=40).
- Assessment of radiological outcomes (union time, angles) and functional/cosmetic outcomes (Flynn's criteria).
Main Results:
- No significant difference in radiological outcomes (union time, Bauman's angle, Lateral humerocapitellar angle) between the two approaches.
- Similar cosmetic outcomes between the medial and posterior triceps splitting approaches (p=0.198).
- The posterior triceps splitting approach showed a significant loss of range of motion (p=0.00), while the medial approach demonstrated statistically better functional outcomes (p=0.00).
Conclusions:
- The medial approach provides superior functional outcomes for pediatric open reduction internal fixation of displaced supracondylar humerus fractures.
- The posterior triceps splitting approach may lead to a greater loss of range of motion.
- Medial approach is recommended for improved functional recovery in pediatric humerus fracture surgery.
Background:
The purpose of this study is to compare the clinical and radiological outcome of medial versus posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children.
Methods:
A retrospective review of total 70 children with medial approach (n=30) and posterior triceps splitting approach (n=40) children was made. Time to radiological union, postoperative Bauman's angle and Lateral humerocapitellar angle was compared for radiological outcome. Cosmetic and functional outcome was assessed and compared using Flynn's criteria.
Results:
Radiological parameters like time to union, postoperative Bauman's angle and Lateral humerocapitellar angle were similar and non-significant between medial and posterior triceps splitting approach. Flynn's cosmetic outcome was similar between these approach (p=0.198). Loss of ROM was significant in posterior triceps splitting approach (p=0.00). Flynn's functional outcome was better with medial approach as compared to posterior triceps splitting approach with statistical significance (p=0.00).
Conclusions:
Medial approach has better functional outcome compared to posterior triceps splitting approach in open reduction internal fixation of displaced supracondylar fracture of humerus in children.
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