Comparison of Functional Outcomes in the Management of Intercondylar Fractures by Olecranon Osteotomy Approach versus Triceps on and Triceps off Approach

Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical treatment includes open reduction and extensive internal fixation. This systematic review aims to evaluate the effectiveness of the surgical approach regarding the functional outcome following intercondylar fracture treatment. A systematic search on literature was performed online from the inception dates to November 2020. Main outcome of interest included functional outcomes, Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand (DASH) Score. Animal studies, case reports, review articles and non-English papers were excluded. Four articles were included in this review. The functional outcome was different among the olecranon osteotomy approach, triceps on with the triceps sparing approach and triceps off with the triceps lifting approach or the TRAP approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon osteotomy approach showed excellent MEPS rate in all age groups. Olecranon osteotomy approach gives better exposure for more accurate anatomical reduction of the intra articular fracture resulting in better functional outcome. Mean DASH score was significantly higher in Triceps Reflecting anconeus (TRAP) group. Olecranon osteotomy approach was found to be better than triceps on approach, with better functional outcome. However, other triceps off (TRAP) did not show any significant differences in terms of functional outcome in the management of intercondylar fractures.Keywords: intercondylar fractures, olecranon osteotomy, triceps on, triceps off, functional outcome.