Comparison of the lateral elbow dislocation approach and nondislocation approach for the reduction and internal fixation of distal humeral coronal fractures

Objective To compare the efficacy of the lateral elbow dislocation approach with that of the nondislocation approach for open reduction and internal fixation of distal humeral coronal fractures. Methods A retrospective cohort study which included 20 males and 32 females, was performed to analyze the clinical data of 52 patients with distal humeral coronal fractures who were admitted to Qilu Hospital(Qingdao) from January 2018 to December 2023 . Classify the fractures according to the Dubberley classification. Overall, 23 patients underwent surgery via dislocation approach and 29 underwent surgery via nondislocation approach. The operation time, intraoperative bleeding volume, incision healing, 3D CT assessment of the reduction within one week after surgery, MEPS at 3 months after surgery, fracture healing and complications at the last follow-up were compared between the two groups. Results All patients were followed for at least one year. The operation time was 149.44±40.29（60~221） minutes in the dislocation approach and 130.38±44.11（67~213） minutes in nondislocation approach group（ P >0.05）. The intraoperative bleeding volume was 124.30±47.02（70~300） mL in dislocation approach and 117.59±43.40（50~200） mL in nondislocation approach group （ P >0.05）. All incisions healed uneventfully in stage I. All patients had good reduction in the dislocation group, whereas only 17 other patients had good reduction and the other 12 patients presented a separation or step>2 mm in the nondislocation group（ P <0.05）. At 3 months after surgery, the MEPS was 90.44±5.82（80~100） points in the dislocation approach group, with an excellent and good rating of 100%. In contrast, the MEPS was 79.83±10.13（60~100） points in the nondislocation approach group, with an excellent and good rating of 75.9%（ P <0.05）.All fractures had healed at the last follow-up. In the nondislocation approach group, osteoarthritis occurred in 11 patients, including 6 with screw protrusion, 3 with heterotopic ossification and 2 of advanced age with osteophyte formation around the joint. In the dislocation approach group, osteoarthritis occurred in only 2 patients of advanced age, with osteophyte formation around the elbow joint, and no screw cutting or heterotopic ossification. Conclusion Compared with the nondislocation approach, the lateral elbow dislocation approach is able to provide complete exposure of the articular surface, achieve anatomic reduction, restore elbow function and reduce complications in distal humeral coronal fractures. Level of evidence Level III; Retrospective Cohort Comparison; Treatment Study