Comparison of Efficacy Between the Bilateral Triceps-Sparing and Olecranon Osteotomy Approaches With Double-Plate Internal Fixation for AO Type C3 Distal Humeral Fractures

AIM: This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation type C3 distal humeral fractures, providing evidence for selecting optimal surgical approaches and fixation methods. METHODS: This retrospective analysis included 31 patients with AO type C3 distal humeral fractures treated at the Department of Orthopaedic Trauma, Orthopaedic Center, the First Hospital of Jilin University between June 2018 and May 2024. All patients underwent open reduction and internal fixation with orthogonal double plates placed dorsally on the radial column and medially on the ulnar column. Based on surgical approach, patients were divided into the BTA group (n = 16) and OOA group (n = 15). The parameters evaluated during this study included injury-to-surgery interval, operative time, intraoperative blood loss, postoperative complications (iatrogenic nerve injury, wound infection, elbow stiffness), and Mayo Elbow Performance Score (MEPS) at 6 and 12 months postoperatively. RESULTS: All patients achieved bony union and their fractures healed with complete follow-up. No statistically significant differences were observed in gender, age, or injury-to-surgery interval between groups (p > 0.05). Operative time was significantly shorter in the BTA group compared to the OOA group (p < 0.05). Similarly, there were no significant differences between the groups regarding intraoperative blood loss, postoperative complication rates, or excellent/good rates of MEPS at 6 or 12 months (all p > 0.05). CONCLUSIONS: For AO type C3 distal humeral fractures without metaphyseal defects, orthogonal double plating provides rigid fixation enabling early postoperative mobilization. For fractures with intact trochlear articular surfaces (no coronal/horizontal split) where fragments can be directly fixed by distal screws from the plates, the bilateral triceps approach may be prioritized. For severely comminuted trochlear fractures with articular fragmentation (coronal/horizontal split) requiring separate fixation of split fragments with headless compression screws, the olecranon osteotomy approach may provide better exposure.