Orthopaedic Surgery and Traumatology Department, Hospital Clínic Barcelona, Barcelona, Spain

Purpose: The olecranon osteotomy approach remains as one of the main problems dealing with the treatment of distal humerus fractures, and complication rates have been reported up to 25%. On the other hand, the difference of visibility of the distal articular surface between the osteotomy and the Bryan-Morrey (B-M) approach is of just the 11% of it all, and even the olecranon osteotomy approach fails to provide visualization of more than 40% of the distal humerus surface. The aim of the present study was to evaluate the feasibility and results after operative treatment of distal humerus fractures type AO 13-C using the B-M approach.

Material and Methods: In  a prospective study between 205 and 2007, 14 patients were surgically treated using the B-M approach. All the cases were AO type 13-C fractures, and all the procedures were performed by the same surgeon (JFV). The ulnar nerve was transposed in every case. The osteosynthesis was performed using 90º plates. Three patients were lost to follow-up. A final evaluation was performed using the Mayo Elbow Performance Score (MEPS) at a minimum follow-up of one year.

Results: The B-M approach allowed a satisfactory exposition to reduce and fixate the fracture fragments in all the cases. One patient required open arthrolisis to treat stiffness. The average MEPS was 94.1. A superficial wound infection occurred in one case, and responded to antibiotic treatment without the need of surgery. Three patients presented a transient ulnar nerve neuropathy. All the fractures healed uneventfully and no implant failure was observed.

Conclusion: Although technically demanding, the Bryan-Morrey approach allows a correct visualization and reconstruction of distal humerus fractures AO 13-C. Regarding the results obtained in the present serie, we aim to reconsider the osteotomy for these type of fractures.