Comparison of clinical outcomes between the olecranon osteotomy approach and the Bryan-Morrey approach for total elbow arthroplasty.

BACKGROUND: This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA). METHODS: In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82 years with a mean age of 62 years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery. RESULTS: Operative time and intraoperative bleeding were less in group A than in group B (53-120 min [70 (62.5, 78) min] vs. 64-105 min [77 (73, 87) min], and 10-200 ml [50 (20, 90) ml] vs. 5-250 ml [100 (50, 150) ml], P < .028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121 ± 12)° vs. (112 ± 10)°, 85 (85,85)° vs. 80 (77,85)°, and (94 ± 3) points vs. (91 ± 4) points, P < .036], while elbow extension and supination activity and complication rates were not statistically significant in either group. CONCLUSION: Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes.

A comparison of functional outcome of intercondylar fracture of distal humerus managed by olecranon osteotomy approach versus triceps sparing approach in adults.

OBJECTIVE: To compare the frequency of satisfactory functional outcome of intercondylar fractures of distal humerus managed by the triceps-sparing approach and olecranon osteotomy approach. METHODS: The randomised controlled study was conducted at Mayo Hospital, Lahore, from September 1, 2012 to August31 2014,and comprised patients> 14 years of age who were admitted through the Accident and Emergency Department and were prepared for surgery to repair intercondylar fractures of distal humerus. The patients were randomly divided into two equal groups. Implants were arranged preoperatively. Patients in group A were managed by open reduction internal fixationvia olecranon osteotomy approach, and those in group B were managed by open reduction internal fixationvia triceps-sparing approach by the same team of surgeons. Mayo Elbow Performance Score was used to assess the functional outcome. Demographic, preoperative and postoperative clinical information of all patients were entered into a predesigned proforma and variables were evaluated statistically. RESULTS: The 150 patients in the study were randomly divided into two groups of 75(50%) patients each. The overall mean age was 49.01±14.63 years. Mean age of group A patients was 53.84±11.86 years and that of group B was 44.19±15.59 years. In group A, there were 67(89.3%) patients who had satisfactory functional outcome and 8(10.7%) had unsatisfactory outcome. In groupB,53(70.7%) patients had satisfactory and 22(29.3%) patients had unsatisfactory functional outcome. CONCLUSIONS: Olecranonosteotomy approach was found to be more effective and preferable compared to the triceps-sparing approach.

[Olecranon osteotomy approach for Dubberley type â ¢ coronal fractures of the distal humerus].

OBJECTIVE: To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience. METHODS: From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded. RESULTS: All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case. CONCLUSION: Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Elbow dislocation approach for complex elbow fractures: a cadaveric study.

BACKGROUND: Approach need to be considered when surgeons dealt with complex elbow injuries and the choice of the approach is a challenge for surgeons due to the complex anatomy. On the basis of releasing the lateral collateral ligament, we modified the dislocation technique to pursue the superior exposure including not only the distal humeral surface but also the anterior facet of the coronoid process. METHODS: A total of 4 cadaver specimens and 8 elbows were included in the study. Each cadaver provided one elbow for either the elbow dislocation approach or the posterior olecranon approach. The exposed distal articular surface of humerus, humeral capitulum, humeral trochlea, anterior trochlea of distal humerus, posterior trochlea of distal humerus and the ulnar coronoid process surface were marked by image J software and calculated for a comparison for each surgical approach. RESULTS: The total distal humeral surface was exposed as a median of 98.2 (97.6, 99.6)% and 62.0 (58.3, 64.5)% for the elbow dislocation approach and the olecranon osteotomy approach (P < 0.001), the capitulum 100% and 32.4 (28.0, 39.2)% (P < 0.001), the trochlea 93.2(90.1, 96.9)% and 72.5 (65.2, 78.8)% (P < 0.001), the anterior trochlear articular surface 96.0(93.0, 97.4)% and 50.3 (43.6, 59.1)% (P < 0.001), the posterior trochlear articular surface 95.4 (93, 100)% and 100% (P = 0.76) and the articular surface of the coronoid process of ulna 71.3 (66.0, 74.2)% and 0% (P < 0.001). CONCLUSION: For complex elbow fractures, the technique of elbow dislocation provides complete exposure of the distal humerus surface and a significant portion of the coronoid process surface, facilitating direct visualization for reduction and fixation. Level of evidence Anatomy Study; Cadaver Dissection.

[Effectiveness of total elbow arthroplasty via olecranon osteotomy approach].

Objective: To investigate the effectiveness of total elbow arthroplasty (TEA) via olecranon osteotomy approach. Methods: Between January 2011 and December 2021, 22 patients (25 sides) with elbow joint disease were treated with TEA via olecranon osteotomy approach. There were 9 males and 13 females with an average age of 52.0 years (range, 32-80 years). The disease involved unilateral elbow joint in 19 cases, including 12 cases on the left side and 7 cases on the right side, and 3 cases with bilateral elbow joints. There were 3 cases (3 sides) of osteoarthritis, 7 cases (9 sides) of rheumatoid arthritis, 6 cases (7 sides) of traumatic arthritis, 4 cases (4 sides) of distal humeral fracture, and 2 cases (2 sides) of elbow tuberculosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were used to evaluate the elbow joint function, and imaging was used to review the position of the prosthesis and the healing of the osteotomy. Results: The operation time ranged from 53 to 120 minutes (mean, 90.6 minutes); intraoperative blood loss ranged from 10 to 200 mL (mean, 68.4 mL). All incisions healed by first intention. All patients were followed up 3.9-126.7 months, with a median time of 47.6 months. At last follow-up, the MEPS scores of 22 patients ranged from 72 to 100 (mean, 91.6); the elbow joint function was rated as excellent in 17 sides, good in 7 sides, and fair in 1 side, with an excellent and good rate of 96%. Elbow joint ROM was 98°-140° in flexion (mean, 119.7°), 5°-23° in extension (mean, 13.9°), 70°-90° in anterior rotation (mean, 83.3°), and 63°-90° in posterior rotation (mean, 79.4°). The follow-up time of 17 patients (20 sides) without fracture and joint stiffness before operation was 3.9-126.7 months, with a median time of 53.9 months; at last follow-up, the MEPS score and the elbow joint ROM were significantly better than those before operation ( P<0.05). The follow-up time of 5 patients (5 sides) with fracture and joint stiffness before operation was 12.0-124.2 months, with a median time of 40.1 months. At last follow-up, MEPS scores ranged from 89 to 100 (mean, 91.2), and elbow joint ROM restored. Two cases (2 sides) developed ulnar nerve symptoms after operation, and 1 case (1 side) suffered from periprosthetic fracture and periprosthetic infection after revision, and the elbow prosthesis was removed. The prosthesis survival rate was 96%. During follow-up, no prosthesis loosening occurred. Conclusion: The intraoperative visual field exposure of TEA via the olecranon osteotomy approach is sufficient, which can reduce the incidence of complications such as triceps weakness and ulnar nerve injury, effectively improve the function of the elbow joint, and obtain satisfactory effectiveness.

Comprehensive review of surgical approaches to the elbow.

The choice of the most suitable surgical approach to the elbow forms the foundation of any successful elbow surgery. The surgical approach is based on the injury or pathology to be addressed and therefore specific anatomical details need to be considered. The surgeon must be comfortable with the bony, ligamentous and neurovascular anatomy of the elbow to consider and execute the best approach for each problem. This is an imperative to avoid iatrogenic injury. This article provides a detailed analysis, valuable technical tips, advantages and disadvantages of the most common approaches to the elbow. The lateral approaches include the Kocher, Kaplan and Extensor Digitorum Communis (EDC) Split approaches, the medial approaches include the Hotchkiss, Flexor carpi ulnaris (FCU) splitting approach, the Taylor and Scham approach. The anterior approach includes the anterior neurovascular interval approach and the posterior approaches include the Olecranon osteotomy, triceps sparing, triceps reflecting approach and finally the Boyd interval approach. The text and illustrations will provide a structured overview for the practicing surgeon.