OTA 2006 Posters
Scientific Poster #148 Upper Extremity
The Posterior Triceps-Sparing Approach to the Humerus:
A Case Series and Technique Description
R. Justin Thoms, MD (n); Frank T. Lombardo, MD (n);
Hamid R. Mostafavi, MD (n);
North Shore University Hospital, Manhasset, New York, USA
Purpose: The posterior triceps-splitting exposure of the humerus
is frequently utilized for internal fixation of fractures involving the
distal humerus and humeral shaft. The potential disadvantages associated
with splitting the triceps include adhesions, postoperative pain, and radial
nerve injury. Anatomic studies detailing a triceps-sparing exposure have
been described, with little clinical evidence published regarding efficacy.
Compared with the standard muscle-splitting approach, a triceps-sparing
exposure may decrease postoperative pain, avoid denervation of the triceps,
allow immediate therapy, and improve range of motion and strength.
Methods: This is a case series of 37 consecutive patients that underwent
operative fixation of humeral fractures by a single surgeon using the triceps-sparing
approach. Patients were followed for up to 2 years. Ages ranged from 16
to 84 years, 54% of patients were female, 43% of injuries involved the dominant
arm, and the mechanisms of injury included high- and low-energy injury.
Nine fractures had intra-articular extension, and 22 were OTA type C fractures
of the humeral shaft or distal humerus. Preoperative radial nerve palsies
occurred in 32% of patients. Evaluation involved subjective accounts of
pain and functional limitation, as well as objective measurements of nerve
function, range of motion, and strength with comparison to the contralateral
(uninjured) extremity.
Results: Of the 37 patients, 34 were available for evaluation. 90%
of patients reported minimal to no limitation in function due to the injury,
and only one patient reported moderate pain with use. All radial nerve palsies
resolved within 6 months following surgery. Two patients developed a postoperative
radial nerve palsy. 35% of patients had an excellent recovery of motion
(loss of 5° or less), and 31% of patients had a loss of range of motion
>20o. The average grip strength recovered was 80%.
Conclusion/Significance: The advantages of the triceps-sparing exposure
of the humerus include relative protection of the radial nerve from injury,
immediate onset of therapy, and preservation of the integrity of the triceps
muscle. Good to excellent results were obtained with nearly all patients
despite severity of injury with respect to pain, function, range of motion,
strength and nerve injury.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.