Methods: Between August 2008 and June 2014, 48 patients with Orthopaedic Trauma Association type C (21 with C2, 27 with C3) distal humerus fractures underwent open reduction and internal fixation with orthogonal precontoured locking plate fixation using the TRAP approach. 147. Incision for exposure of the elbow joint. lifting approach or the TRAP approach. humerus, humeral shaft, and distal humerus. Currently the olecranon osteotomy approach is the most commonly used. The TRAP approach does not denervate the anconeus muscle and there is no risk of olecranon nonunion.6 Sachdev et al., 7 found the triceps-reflecting anconeus pedicle approach had less . Stable fixation is difficult to achieve, especially in fractures with extensive comminution or when . The TRAP (triceps-reflecting anconeus pedicle) approach provides adequate exposure for a surgeon experienced with the technique. Orthop Clin North Am 2000;31:91-101; Jupiter J, Goodman I. Both approaches can achieve reduction in distal fragments for different feature types. In our experience, poor initial fracture fixation is the most common risk factor for fracture nonunion. The authors of the current study have developed and used for the past 11 years a philosophy and technique based on principles that maximize fixation in the distal fragments and compression at the supracondylar level that has allowed them to routinely commence an intensive rehabilitation program 36 hours after surgery. 7. . Orthop Clin North Am. J Shoulder Elbow Surg 1992;1:37-46 The management of complex distal humerus nonunion in the elderly by elbow capsulectomy, triple plating, and ulnar nerve neurolysis. The TRAP approach is extensile enough in treating complex humeral fractures. Occurrences of bony union, implant Occurrences of bony union, implant Distal humerus fractures have a bimodal age distribution, with peak incidences occurring between the ages of 12 and 19 years in . between the brachialis (musculocutaneous n. and radial n.) and brachioradialis (radial n.) Ensure that the lateral antebrachial cutaneous nerve is retracted with the biceps. This must be traced proximally until it . The triceps preserving approach to total elbow arthroplasty. O'Driscoll has described a triceps reflecting anconeous pedicle approach (TRAP) that avoids an osteotomy. The clinical outcome parameters of our series revealed excellent maintenance of strength compared to the contralateral side. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Outcome of olecranon osteotomy in the trans-olecranon approach of intra-articular fracture of the distal humerus. Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure. Results: The most common type of fracture observed was C2 (53.4%) and was associated with fracture of distal radius (26.6%) followed by fracture metacarpals (13.2%). The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral 449 fractures and nonunions. Results. Clin Orthop Relat Res. 1998;(354). The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Using the TRAP approach, the percentage was 46.1 %. Anterolateral Approach to Distal Humerus. 2000;31(1):91-101. 1998;(354). Background: Dual-plating osteosynthesis is the standard treatment for Orthopedic Trauma Association (OTA)-type 13-C distal humerus fractures.However, optimal plate position is debated. pedicle (TRAP), triceps-splitting, and olecranon osteotomy techniques. Zlotolow DA, Catalano LW III, Barron OA, Glickel SZ. Orthop Clin North Am. 21. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions Adequate exposure is a prerequisite for treatment of distal humeral fractures, as with most surgical procedures. To assess the range of movements, functional outcome at end of 2000; 31:91-101. For instance, in a series of thirty-four complex distal humerus fractures by Sanchez-Sotelo et al. Alert. In addition, the TRAP approach permits total elbow arthroplasty and open reduction and internal fixation through the same exposure. Background: The purpose of this retrospective study was to identify the patterns of distal humeral articular fractures and to analyze the results of open reduction and internal fixation of these injuries. 2000;31(1). Purpose: The purpose of this study was to evaluate dual-plate positioning following intra-articular distal humerus fracture repair by comparing outcomes between patients plated in parallel and those plated . Keywords: Distal humerus, internal fixation, intra-articular fracture, olecranon osteotomy; TRAP. Thirty three patients with intra-articular distal humerus fractures were retrospectively analysed. The distal humeral fractures take up 1-7% of all fractures and constitute 30% of all elbow fractures. displaced intra-articular distal humeral fractures with the use of TRAP approach. Posterior surgical approaches to the elbow: a simple method of comparison of the articular exposure. 452 28. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures. Extensive posterior exposure of the elbow: a triceps-sparing approach. 1982; (166): 188-92. Cancel Save. Distal Humerus. In the medial‐lateral group, the medial approach could expose 2/5 of the medial trochlea and 1/3 of the capitellum, while the mean visible size of the distal humeral articular surface was 6.8 cm 2, 34.8% of the entire surface; the lateral approach can expose 3/7 of the capitellum and 1/4 of the medial trochlea, while the mean visible size of the distal humeral articular surface was . . The distal humeral fractures are clinically difficult to manage, especially the intra-articular fracture. O'Driscoll SW. 3. Orthop Clin North Am. Ulnar neuropathy following distal humerus fracture fixation. A triceps-sparing approach. The TRA is a valuable option for ORIF in distal intraarticular humerus fractures. To assess the functional outcome and to compare the results after surgical management of intra articular fracture of distal humerus using Mayo elbow performance index. The triceps-reflecting anconeus pedicle approach (TRAP) is another commonly used approach for treatment of comminuted intraarticular fracture of distal humerus. Orthop Clin North Am and locking plate fixation for distal humerus fractures [26,33,34], 2000;31:91-101. other studies revealed more long-term complications related to [9] Athwal GS, Rispoli DM, Steinmann SP. Expand. TRAP approach was used in 17 patients (10 males, 7 females; mean age 35.9 years, range 17-70), and olecranon osteotomy in 16 patients (11 males, 5 females; mean age 34.4 years, range 18-62). Orthop Clin North Am. ortho BULLETS. Surgeon opinion regarding the optimal surgical approach to distal humerus fractures is widely divergent. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. It preserves the normal joint anatomy of the olecranon and avoids the potential complications associated with olecranon osteotomy. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach. Campbell WC. 2. This approach is a combination of modified Kocher and Bryan-Morrey, mobilizes the triceps. Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical . Session 6 Hospital Clinico San Carlos de Madrid. All described approaches have its own merits and demerits.with this we are assessing outcome of these distal humerus fracture fixation with triceps reflecting approach. Congruent articular reconstruction is mandatory for an acceptable functional recovery. Surgical technique by investigation . However, the results of those two elbows were not explained in detail. Pierce TD, Herndon JH. 2000; 31(1):91-101. Objectives: To evaluate and compare the results of TRAP . Bolukbasi T, Intercondylar fracture of distal humerus treated with triceps-reflecting anconeus pedicle approach. Materials and Methods: This was a case series of 30 patients of distal humeral intraarticular fractures treated by open reduction and internal fixation and followed . Alicia Worden, A. Ilyas; Medicine. Bryan RS, Morrey BF. The nerve is generally easiest to find in the distal arm, just proximal to the elbow. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Introduction For midshaft and distal shaft fractures, the posterior approach may be extended distally, leaving the triceps insertion intact. Most common surgical approaches used in treating comminuted distal humerus fractures were olecranon osteotomy (OO) and triceps sparing. with distal humerus locking plates or reconstruction plates, fifteen cases via olecranon osteotomy approach and seven fractures fixed by triceps reflecting anconeus pedicle (TRAP) approach. 4/20/2021. TOPICS . 8. intra -articular distal humerus fractures treated with triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy. O'Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. Tak SR, Dar GN, Halwai MA, Kangoo KA, Mir BA. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Both articular reconstruction and fixation can be easily managed without creating an olecranon fracture. Crossref Medline, Google Scholar; 7. In this anatomical study, 12 adult fresh-frozen cadaveric elbows were randomly divided into a medial-lateral group and an olecranon osteotomy group, with 6 in each group. Physiotherapy was started from 1st post-op day with unprotected ROM exercises were allowed by 3rd week. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. The triceps-reflecting anconeus pedicle (TRAP) approach described in this article fulfills these prerequisites and, to the author's knowledge, might be the only approach for the treatment of complex, comminuted articular fractures of the distal humerus that does meet all these criteria. All the fractures were fixed using the AO bi-columnar plating techniques with distal humerus locking plates or reconstruction plates, fifteen cases via olecranon osteotomy approach and seven fractures fixed by triceps reflecting anconeus pedicle (TRAP) approach. Orthop Clin North Am. TRAP APPROACH • The entire triceps-anconeus flap • is then reflected proximally releasing the triceps muscle • from the posterior aspect of the distal humerus 35. [15] We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation. Orthop Clin North Am 2000, 31(1):91-101. watch video. Dakouré PW, Ndiaye A, Ndoye JM, et al. Materials and Methods: We reviewed the functional and radiological results of 40 consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. 85 plays. 452 28. MATERIALS AND METHODS Forty patients who were treated with ORIF with the diag-nosis of adult distal humerus intra-articular fracture accord- of images. The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fracture of the olecranon and its associated complications. The management of complex distal humerus nonunion in the elderly by elbow capsulectomy, triple plating, and ulnar nerve neurolysis. 2000;31(1). Materials and Methods:We prospectively reviewed results of TRAP approach on cohort of 30 patients with intraarticular fracture lower end humerus over a duration of June 2012 to Aug. 2014. Proximally, the circumflex humeral vessels and the Conclusion: TRAP approach allows adequate fracture visualization of distal humerus for stable fixation of intra-articular fractures without creating an iatrogenic fracture of olecranon and its associated complications. Arch orthop trauma 2005;125:469-74. O'Driscoll S. The triceps reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Dr. Diaz: Fragment specific fixation in distal radius fracture. 3 This approach is a combination of modified Kocher and Bryan-Morrey, mobilizes the triceps and anconeus muscle of the posterior humerus and proximal ulna, and also provides adequate exposure of distal humerus. Prof. Bégué: The TRAP approach for complex fractures of the distal humerus in the elderly. TRAP APPROACH • Advantages - Good exposure to the posterior elbow joint - Avoid complications of osteotomy • Disadavntages - Triceps is completely released . Methods: Thirty three patients with intra-articular distal humerus fractures were retrospectively analysed. In other cases, routine approaches like TRAP, paratricipital or Triceps splitting approach were used. Ring D, Gulotta L, Chin K, Jupiter JB. Nonunion or hardware failure have been reported in approximately 8% to 25% of recent series on distal humerus fractures. TRAP approach was used in 17 patients (10 males, 7 females; mean age 35.9 years, range 17- TRAP approach, as defined by O'Driscoll et al., [12] is an alternative approach in these fracture patterns. They are among the most difficult fractures to treat. 2018;42(11):2653-62. The main advantages of the TRAP approach are that it avoids hardware complications and olecranon nonunion and does not potentially contribute to post-traumatic arthritis or intra-articular adhesions. Patterson SD, Bain GI, Mehta JA. Int Orthop. Private Note. O'Driscoll S. The triceps reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. 1 OO was commonly selected for the treatment of intraarticular comminuted cases, especially for type C3. , the triceps-sparing approach was performed in two elbows, whereas the TRAP was used in seventeen elbows and the olecranon osteotomy in five. Olecranon osteotomy was the most common surgical approach (40%). Crossref Medline, Google Scholar; 7. Orthop Clin North Am. A number of surgical approaches can be used to treat intra-articular fractures of the distal humerus to obtain good articular exposure, including the olecranon osteotomy approach , the triceps-reflecting anconeus pedicle (TRAP) approach , the triceps-splitting approach , the extensor mechanism-sparing paratricipital posterior approach , and the . In the . O'Driscoll S: The triceps reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. approach for complex intra-articular distal humeral fractures. 1932; 15(1):65-67. This provides adequate exposure for reduction and fixation. Levine WN. This is a relatively uncommon injury, comprising approximately 2% of all fractures and one-third of all humerus fractures. 4. of comminuted distal humerus fracture. Orthop Clin North Am. Described approaches include the triceps‐splitting, olecranon osteotomy, triceps‐reflecting (Bryan-Morrey), triceps‐reflecting anconeus pedicle (TRAP), and para‐tricipital approaches. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthop Clin North Am. Introduction: Treatment choice for displaced, intercondylar fractures of the distal humerus is open reduction and internal fixation (ORIF) through a posterior approach. The interval between anconeus and extensor carpi ulnaris is used to elevate the anconeus muscle and develop the distal lateral portion of the flap. A&B distal humerus fracture fixation, we have been using Alonso-llames triceps-on approach for type C 1 & C 2 distal humerus fractures. Articular fractures of elbow are the most difficult one to treat. This study was undertaken to assess outcome of osteosynthesis of AO type C 1 & C 2 fractures of distal humerus using Alonso-llames triceps-on approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon . The favorite treatment for intra-articular distal humeral fractures is open reduction and internal fixa-tion (ORIF). 2000; 31(1): 91-101. of comminuted distal humerus fracture. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures. distal humerus fxs (type C2 or C3) in women >65yo • Retrospective review of 24 patients • Outcomes - ORIF: 4 excellent, 4 good, 1 fair, 3 poor - TEA: 11 excellent, 1 good • Conclusions: TEA is a viable treatment option for distal intra -articular humerus fxs in women >65yo • McKee et al COTS Study JSES The clinical outcome parameters of our series revealed excellent maintenance of strength compared to the contralateral side. We help you diagnose your Distal humerus case and provide detailed descriptions of how to manage this and hundreds of other pathologies Indian J Orthop. To determine the visible size of the distal humeral articular surface by using a novel combined medial-lateral approach as an alternative method of surgical treatment for intra-articular distal humeral fractures. Materials and methods: Eleven patients with intercondylar fractures of the humerus operated with this approach were reviewed. Zalavras CG, Papasoulis E. Intra-articular fractures of the distal humerus-a review of the current practice. Methods: Between August 2008 and June 2014, 48 patients with Orthopaedic Trauma Association type C (21 with C2, 27 with C3) distal humerus fractures underwent open reduction and internal fixation with orthogonal precontoured locking plate fixation using the TRAP approach. The medial portion of Session 5 Università Campus Bio-Medico di Roma. Pankaj A, Mallinath G, Malhotra R, Bhan S. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. 10.1016/S0002-9610(32)90997- The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral 449 fractures and nonunions. CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates. 5.0 (1) EXPERT COMMENTS (3) Please login to add comment. Orthop Clin North Am. 2000; 31:91-101. Materials and . Ring D, Gulotta L, Chin K, Jupiter JB. Clin Orthop 451 Relat Res. The management of complex distal humerus nonunion in the elderly by elbow capsulectomy, triple plating, and ulnar nerve neurolysis. 2007;41(3):219-23. land-transolecranon approach should be preserved in J . 450 27. 6,9,14,19,20. Posterior triceps-sparing approach (triceps-on) 1. »Review historic and modern literature to develop an evidence-based approach to intraarticular distal humerus fractures. third (2%) are distal humeral fractures. Introduction Intercondylar fractures of the distal humerus (OTA, Type C) constitute 1% of all fractures in the adults [ 6, 7 ]. Approaches | Lateral Approach to Distal Humerus Approaches - Lateral Approach to Distal Humerus; Listen Now 5:31 min. Chou YC, Hsu YH, Yu YH, Wu CC. Triceps-reflecting anconeus pedicle approach with double precontoured locking plate fixation is efficient in the treatment of . Bryan RS, Morrey BF. Restoration of painless and satisfactory elbow function after a fracture of . It preserves the normal joint anatomy of the olecranon and avoids the potential complications associated with olecranon osteotomy.

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