Functional Outcomes and Complications of Olecranon Osteotomy Versus Triceps-Reflecting Approach for Intra-Articular...

Distal humerus fractures are rare but complex, needing stable fixation and early mobilization. Olecranon osteotomy offers good exposure but risks non-union and implant issues, while extensor-preserving approaches may reduce morbidity yet limit visualization. Limited Indian data call for context-specific outcome studies.

To evaluate and compare the functional recovery and complication profile of olecranon osteotomy and triceps-reflecting approaches in the surgical management of intra-articular distal humerus fractures in an Indian cohort.

This prospective observational study was conducted at a tertiary hospital in Chennai between January 2023 and June 2025. Thirty-two adults with type II-IV intra-articular distal humerus fractures were enrolled, with 16 patients managed by olecranon osteotomy and 16 by triceps-reflecting approach. Functional recovery was assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and goniometric range of motion (ROM) at 1, 3, and 6 months. Postoperative complications were systematically documented. Data were analyzed using independent t-tests, Mann-Whitney U, and Chi-square/Fisher's exact tests.

At 1 month, olecranon osteotomy showed significantly better MEPS, DASH, and ROM, but by 6 months outcomes converged between groups. Complication rates were higher with olecranon osteotomy (62.5% vs. 37.5%), including implant prominence and osteotomy-specific problems, though differences were not statistically significant.

Both approaches give good recovery. Olecranon osteotomy offers better early results but more complications, while triceps-reflecting provides similar long-term outcomes with fewer risks.