Management of intercondylar fractures of the humerus using the extensor mechanism-sparing paratricipital posterior approach.

Twenty two patients with intra-articular fractures of the distal humerus were operatively treated using the extensor mechanism-sparing paratricipital approach as described by Schildhauer et al. All fractures were AO type C (six AO type C1, 11 C2 and five C3). There were 16 males and six females with a mean age of 32.5 years. Internal fixation was achieved with bilateral plates and screws. The results were evaluated after a mean follow-up period of 30 months using Mayo Elbow Score. The results were graded as excellent in 13 patients (59.2%), good in six (27.3%), fair in two patients (9%) and poor in one (4.5%). The average range of flexion was 120 degrees +/- 8 degrees (range: 100 to 140), extension 6 degrees (range: 0 to 15). Eighty-two percent of patients had normal muscle strength in comparison to the contralateral side and 18% had good muscle strength. The average time to union was 2.4 +/- 1.6 months (range: 2 to 4). No implant failure, neurovascular deficit or nonunion was noted. There was one deep infection. The extensor mechanism-sparing paratricipital approach is an invaluable approach for fixation of intercondylar fractures of the humerus without negative effects on triceps strength; however it is not recommended for multifragmentary type C3 fractures.