Functional Outcomes and Complications of Olecranon Osteotomy Versus Triceps-Reflecting Approach for Intra-Articular Distal Humerus Fractures in Adults - A Prospective Observational Study from South India

Sep 30, 2026

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Distal humerus fractures are rare yet complex, requiring stable fixation and early mobilization while balancing surgical exposure and extensor preservation. This prospective observational study compared olecranon osteotomy with triceps-reflecting approaches for intra-articular distal humerus fractures in an Indian cohort. Thirty-two adults (type II–IV) were followed at 1, 3, and 6 months using MEPS, DASH, and goniometric ROM, with complications documented postoperatively. Olecranon osteotomy showed better early function, whereas long-term outcomes converged despite higher osteotomy-related complication rates.

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Abstract

Background, Objectives, Methods, Results, Conclusions

Introduction

Materials and Methods

Original Research Functional Outcomes and Complications of Olecranon Osteotomy Versus Triceps‑Reflecting Approach for Intra‑Articular Distal Humerus Fractures in Adults: A Prospective Observational Study from South India Prithivi Selvan1, Murali Krishnan1, Thiagarajan Pandian1, Panneerselvam Periasamy2 1Department of Orthopaedics, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, 2Department of Physiology, Government Erode Medical College, Erode, Tamil Nadu, India Submitted: 10‑Oct‑2025 Revised: 05‑Nov‑2025 Accepted: 08‑Nov‑2025 Published: 22‑Dec‑2025 Abstract Background: Distal humerus fractures are rare but complex, needing stable fixation and early mobilization. Olecranon osteotomy offers good exposure but risks non‑union and implant issues, while extensor‑preserving approaches may reduce morbidity yet limit visualization. Limited Indian data call for context‑specific outcome studies. Objectives: To evaluate and compare the functional recovery and complication profile of olecranon osteotomy and triceps‑reflecting approaches in the surgical management of intra‑articular distal humerus fractures in an Indian cohort. Methods: This prospective observational study was conducted at a tertiary hospital in Chennai between January 2023 and June 2025. Thirty‑two adults with type II–IV intra‑articular distal humerus fractures were enrolled, with 16 patients managed by olecranon osteotomy and 16 by triceps‑reflecting approach. Functional recovery was assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and goniometric range of motion (ROM) at 1, 3, and 6 months. Postoperative complications were systematically documented. Data were analyzed using independent t‑tests, Mann–Whitney U, and Chi‑square/Fisher’sexact tests. Results: At 1 month, olecranon osteotomy showed significantly better MEPS, DASH, and ROM, but by 6 months outcomes converged between groups. Complication rates were higher with olecranon osteotomy (62.5% vs. 37.5%), including implant prominence and osteotomy‑specific problems, though differences were not statistically significant. Conclusions: Both approaches give good recovery. Olecranon osteotomy offers better early results but more complications, while triceps‑reflecting provides similar long‑term outcomes with fewer risks. Keywords: Complications, distal humerus fracture, functional recovery, olecranon osteotomy, triceps‑reflecting approach Introduction Distal humerus fractures and fractures account for ~2% of adult one‑third of humerus fractures, seen in young males (high‑energy) and elderly females (low‑energy) . They challenge stable fixation and early mobilization.[1] Surgery must balance exposure and extensor preservation. Olecranon osteotomy offers excellent access but risks non‑union and hardware issues. Triceps‑reflecting avoids these risks, offering good recovery but limited exposure in complex fractures.[2] | Access this article online | | | --- | --- | | Quick Response Code:
| Website: [https://journals.lww.com/jpbs](https://journals.lww.com/jpbs) | | | DOI: 10.4103/jpbs.jpbs_1650_25 | Recent studies comparing triceps reflecting anconeuspedicle approach (TRAP) and olecranon osteotomy show similar 12‑month functional outcomes, including flexion‑extension arc, Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, Address for correspondence: Dr. Prithivi Selvan, Department of Orthopaedics, Sree Balaji Medical College and Hospital, No 7 CLC Works Road, Chrompet ‑ 600 044, Chennai, Tamil Nadu, India. E‑mail: [prithiviselvan@gmail.com](prithiviselvan@gmail.com) This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permi

FAQs

What was the objective of the study comparing olecranon osteotomy and triceps-reflecting approaches?

To evaluate and compare functional recovery and the complication profile of olecranon osteotomy versus triceps-reflecting approaches for intra-articular distal humerus fractures in an Indian cohort.

How were functional outcomes measured and when were they assessed?

Functional recovery was assessed using MEPS, DASH, and goniometric range of motion at 1, 3, and 6 months after surgery.

What differences were observed in complications between the two approaches?

Complication rates were higher with olecranon osteotomy (62.5% vs. 37.5%), including osteotomy- and implant-related issues, though statistical significance was not reached.

Sep 30, 2026

Uploaded by dhado