Distal humerus fractures treated with the anconeus-triceps lateral flap approach: a case series of 10 consecutive patients.

Background: The surgical management of distal humeral fractures remains challenging. Posterior approaches involving the triceps mechanism are crucial for achieving stable fixation and functional recovery but are associated with potential approach-related complications. Traditional approaches often involve olecranon osteotomy to achieve adequate exposure, but this technique is associated with specific complications. The purpose of the present study is to describe the clinical outcomes and surgical rationale of the anconeus-triceps lateral flap (ATLF) approach applied to open reduction and internal fixation of distal humerus fractures and reports preliminary outcomes with a minimum follow-up of 24 months, highlighting its potential advantages in exposure, functional recovery, and intraoperative versatility. Methods: Ten consecutive patients with distal humeral fractures underwent open reduction and internal fixation with dual plating through the triceps ATLF approach, which preserves the olecranon and the medial portion of the triceps tendon insertion. The surgical rationale of this technique is to enhance articular visualization while maintaining extensor mechanism integrity through partial, controlled triceps detachment. Clinical outcomes were assessed using the Mayo Elbow Performance Score, the Quick Disabilities of the Arm, Shoulder and Hand questionnaire, the visual analog scale score, and radiographic evaluation of fracture healing. Results: At final follow-up, all patients achieved fracture healing and returned to work within 6 months. Nine patients reported overall satisfaction with the procedure. Mean outcome scores were: Mayo Elbow Performance Score 89.5 ± 10.39, Quick Disabilities of the Arm, Shoulder and Hand 7.03 ± 4.72, and visual analog scale 1.6 ± 1.89. All the patients in this group preserved the ability to keep the elbow against gravity with the forearm extended over the head. No major complications (requiring further surgery) attributable to the surgical approach or approach-related fixation failure were observed. Some minor complications occurred, such as ulnar nerve neurapraxia in 2 cases, heterotopic ossifications in 3 cases, and triceps decrease in strength in one patient. Conclusion: This triceps approach provides a clinically effective balance between improved articular exposure and functional preservation of the extensor mechanism. The ATLF technique represents a valuable option for distal humerus fracture treatment within contemporary orthopedic practice, with the added advantage of enabling straightforward conversion to total or hemiarthroplasty if required.