Surgical treatment for distal humerus fractures in adults (type C fractures) by tricep tongue lifting (V-Y PLASTY) approach

Abstract

Objective: To evaluate the functional outcome of the Triceps Tongue Lift Approach for distal humerus type C fractures in adults. Methodology: Twenty-two cases (16 males and 6 females) of distal humeral fractures were included in this prospective study conducted between January 2015 to January 2017. The study was conducted at services hospital, Lahore, Pakistan. The average age was 45 years (range 35-54). Open reduction and internal fixation were performed in all cases. A triceps tongue lifting approach was used and parallel plating technique was chosen for all fractures. The elbow was splinted with back slab, which was removed after 3 weeks of operation. Rehabilitation was started on the next day of operation. Patients were called for follow up at 1, 2, 4, 6 and 12 months during which complete history, physical examination and radiographs were recorded. Completion of Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, Recording of Range of motion at elbow joint, and Objective Muscle Strength Testing (MRC Grade) of triceps muscle were done. Results: Out of 22 patients, 16(72.7%) were male and 6(27.3%) female with the mean age of 45.0±5.8 years. The mean duration of follow up was 16.8±4.5 months (Range 8-24). Mean flexion contracture was 10.5Ëš±7.8Ëš and mean arc of flexion extension was 111.8 Ëš±19.7Ëš. The mean DASH score at final follow up was 7.0±0.6, indicating mild residual impairment. Conclusion: A tricep tongue lifting (V-Y plasty) approach is an excellent approach to provide adequate exposure to the joint, and provides good functional outcome, complete range of motion at elbow joint and almost complete recovery of triceps muscle power.