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Comparative study of different approaches for open reduction and internal fixation in fractures of distal humerus

Background: Open reduction internal fixation (ORIF) of distal humerus fracture is the gold standard treatment but controversies exists regarding surgical approaches, type of implants, operative techniques, need for transposition of ulnar nerve, and type of rehabilitation after surgical treatment. Aims: To analyze the functional outcome of open reduction and internal fixation of distal humerus fracture using three different posterior approaches namely: olecranon osteotomy, Campbell′s approach, Bryan Moorey approach. Materials and Methods: This prospective randomized observational study of 60 cases of intercondylar fracture of humerus was conducted in the Department of Orthopedic Surgery in a tertiary care hospital in West Bengal over a time span of two years after taking Institutional ethical clearance and informed consent of the patients. Out of 60 cases, olecranon osteotomy approach was used in 20 cases; Campbell′s approach in 20 cases; and Bryan Moorey approach in 20 cases. Results: At final follow up, all patients were assessed by Mayo Elbow Performance Index (MEPI) scoring system. We found best results in patients operated by olecranon osteotomy approach (18 patients had excellent result) whereas only eight cases in Bryan Moore group and six cases in patients operated by Campbell′s approach had excellent result. However, when statistically analyzed the mean results of three groups the results were statistically insignificant (P = 0.09). Conclusion: It can be concluded that among that three approaches being studied for intercondylar fracture humerus, the olecranon osteotomy approach provides adequate exposure to distal humerus facilitates accurate articular reduction even in complex type of fractures and early mobilization can be instituted, which is the crux for the final outcome.