Comparative Outcomes of TRAP Approach and Olecranon Osteotomy in Intra-Articular Distal Humerus Fractures

Background: Intra-articular facture of the distal humerus can be managed using various techniques and technologies as TRAP approach and olecranon osteotomy. However, the comparison of two technique in Indian context is scarce. 

Aim: The present study was aimed to comparatively evaluate the functional outcomes of triceps-lifting approach (TRAP) and olecranon osteotomy in the management of intra-articular distal humeral fractures. 

Methods: The present study assessed 40 subjects divided into two groups of 20 subjects each where subjects from Group I were managed with olecranon osteotomy and Group II subjects with triceps-lifting approach (TRAP). In the two groups, subjects were comparable at baseline for degree of fracture comminution, duration of injury, gender, and age. The results in two groups were compared concerning complications, range of motion, hospital stay, and operative time. Functional evaluation was done utilizing the MEPS (Mayo elbow performance score) and were followed for 1 year.  

Results: The study results showed that fracture was united at or before 4 months in all subjects except for 2 subjects from Group II where fracture union was seen at 7 months. Mean time for union was comparable in two groups. Mean union time in two groups was statistically comparable with p>0.05. In Group I, mean extension loss and degree of flexion was 12±4.68 and 118.23±4.92, whereas, in Group I, it was 11±3.82 and 118±7.31 respectively. Mean range of motion was comparable in two groups and non-significant difference was seen MEPS with p=0.551. Overall rate of complications was 30% in olecranon osteotomy and 40% in TRAP.

Conclusion: The present study concludes that intra-articular distal humerus fracture necessitates its surgical fixation for attaining best functional outcomes. Despite being technically challenging, TRAP exposure is comparable in efficacy to olecranon osteotomy approach with both the techniques depicting no significant differences concerning functional and clinical results for the management of intra-articular distal humerus fracture.