What type of study is this?

This is a Systematic Review study.

December 8, 2025Open Access

Clinical outcomes following Triceps-Reflecting Anconeus pedicle (TRAP) approach for treating intercondylar distal humerus fractures: A systematic review

SYShahabeddin Yazdanpanah BGBraeden R. GoochVirginia Commonwealth University JCJohn CyrusVirginia Commonwealth University

Key Points

Union rates were consistently high, with reported cases achieving full recovery from distal humerus fractures.
The analysis covered twelve observational studies, including 295 individuals with an age average of 38.7 years, highlighting diverse backgrounds.
Observed complications included a notable 8.8% of cases related to the ulnar nerve, emphasizing the need for careful monitoring during recovery.
Positive outcomes regarding range-of-motion metrics were recorded, but clinical caution against infection remains advised.

Abstract

Abstract Purpose Distal humerus fractures (DHFs) constitute 2% of all fractures, with open reduction and internal fixation (ORIF) often indicated for treatment. Within ORIF literature exists the triceps-reflecting anconeus pedicle (TRAP) approach: an alternative that offers adequate exposure while preserving key soft-tissue structures hypothesised to improve outcomes. Despite this, TRAP-related findings remain poorly collated and lacking consensus. Thus, this systematic review aims to synthesise TRAP-utilising intercondylar DHF ORIF outcomes to guide and inform surgical decision-making. Methods A PROSPERO-pre-registered query searched PubMed, Ovid-Embase, Cochrane, and Web of Science on June 26th, 2025, for relevant studies. Demographics, range-of-motion (ROM), and complications were among extracted variables. Frequency-weighted means (FWM) and standard deviations, supplemented by narrative synthesis, constituted data analyses. Results Twelve moderate quality observational studies were included ( n = 295; 59.6% male; FWM age 38.7 ± 10.8 years; follow-up 26.1 ± 9.5 months). All patients underwent TRAP approach DHF ORIF for AO type C fractures (C1 = 29.4%; C2 = 40.7%; C3 = 29.9%), most often from falls or motor vehicle accidents. Union was reported in all cases, and at a FWM 15.7 ± 4.7 weeks. FWM Flexion-extension arc was 113.8˚ ± 12.3, prosupination arc was 157.9˚ ± 8.1, and Mayo Elbow Performance Score was 85.5 ± 8.3. The pooled complication rate was 26.5%, with ulnar nerve-related issues (8.8%) and infection (8.5%) most frequent. Conclusion The TRAP approach to DHF ORIF appears to yield favorable union, ROM, and functional outcomes; however, ulnar nerve-related issues and infection warrant relative caution. Future large, randomised trials are needed to better optimise alternative surgical approach selection strategies. Level of evidence Level III.

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