Yoon Yong-Cheol, Oh Hyoung-Keun, Kim Hyung-Suh, Kim Joon-Woo
Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong-gu, Incheon 21565, Republic of Korea.
Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Ilsanseo-gu, Goyang-si 10380, Gyeonggi-do, Republic of Korea.
J Clin Med. 2025 Apr 22;14(9):2890. doi: 10.3390/jcm14092890.
: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. : This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups ( = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, = 0.03). However, intraoperative blood loss ( = 0.36), Mayo Elbow Performance Score ( = 0.71), range of motion ( = 0.36), and complication rates ( = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group ( = 0.17), and four cases required implant removal due to discomfort ( = 0.18) in the anterolateral group. : Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection.
肱骨远端骨干骨折（DHSFs）因靠近肘关节、骨量有限以及存在桡神经损伤风险而带来手术挑战。本研究比较了前外侧和后正中保留肱三头肌入路的临床和影像学结果，以确定最有效的手术策略。：这项多中心回顾性研究纳入了75例在2015年至2021年间接受DHSF手术的患者，这些患者至少随访一年，远端骨折块≥3 cm，且术前无桡神经损伤。50例患者通过前外侧入路进行前路钢板固定，25例患者进行后路钢板固定。对临床和影像学结果进行了评估。74例患者（98.7%）实现了骨愈合，两组之间无显著差异（P = 0.21）。前外侧入路的手术时间较短（116±29.4 vs. 143±31.4分钟，P = 0.03）。然而，术中失血量（P = 0.36）、梅奥肘关节功能评分（P = 0.71）、活动范围（P = 0.36）和并发症发生率（P = 0.21）无显著差异。后正中入路组发生了2例短暂性桡神经麻痹（P = 0.17），前外侧入路组有4例因不适需要取出植入物（P = 0.18）。：两种入路均能有效治疗DHSFs，骨愈合率高，功能结果相当。然而，由于仰卧位、直接入路和避免桡神经解剖，前外侧入路显著缩短了手术时间。当无法实现稳定的前路固定时，后路钢板固定仍然可行。进一步的研究应评估长期结果以及影响入路选择的因素。
