A Comparative Analysis of Triceps-Splitting Versus Paratricipital Surgical Approaches in The Management of Extra-Articular Distal Humerus Fractures: A Prospective Cohort Study.

Background: Extra-articular distal humerus fractures (EDHFs) are common in both younger and older adults, presenting clinical challenges related to fracture complexity and patient comorbidities. This study compares the triceps-splitting and paratricipital surgical approaches to determine which method optimizes clinical outcomes over a 6-month follow-up period. Materials and Methods: In this prospective cohort study, 120 patients with radiographically confirmed EDHF were assigned to undergo either the triceps-splitting or paratricipital approach. Each patient was assessed at baseline, 3 months, and 6 months postoperatively for surgical site infection, nerve injury, pain (using a 10-point visual analog scale), and range of motion (using a universal goniometer). Data were analyzed via Chi-square test, Fisher's exact test, and Kruskal-Wallis test. Results: Baseline characteristics, including age, gender, and hospital stay, did not differ significantly between groups. At 6 months, patients who underwent the paratricipital approach reported significantly lower pain levels and demonstrated fewer limitations in extension compared to the Triceps-Splitting group. While infection and nerve injury rates were low and similar in both cohorts, the paratricipital approach showed a lower necessity for reoperation and reduced postoperative complications. Conclusions: Both the triceps-splitting and paratricipital approaches effectively manage EDHF. However, the paratricipital technique may confer advantages in terms of pain reduction, triceps function preservation, and lower reoperation rates. Surgeons should consider individual patient factors and fracture characteristics when selecting the optimal surgical approach.