Distal coronal humerus fractures are relatively rare in clinical practice, accounting for only 6% of distal humerus fractures and 1% of elbow fractures. With this type of fracture involving the humeral head or trochlea, anatomic reduction and firm fixation of the ulnar and radio-radial articular surfaces are essential to achieve satisfactory recovery of elbow motion. The mechanism of injury is mainly due to the axial load imposed on the distal humerus by the force transmitted through the joint, resulting in a coronal shear fracture of the capitulum or trochlea. About 60% of distal humerus coronal fractures are associated with radial head fracture or ulnar tract injury of lateral collateral ligaments. While the integrity of the ligaments is equally essential for the recovery of elbow function, the attachment of the lateral collateral ligaments makes the fracture reduction and fixation of the distal posterior condyle of the humerus more difficult. Surgical treatment of distal humeral coronal fracture includes fracture mass excision, open reduction, internal fixation, arthroscopic assisted reduction and fixation, elbow joint replacement, etc. Surgical approaches mainly include lateral, anterolateral, and posterior olecranon osteotomy approaches. Given the complexity of the distal humeral coronal fracture, surgical exposure and fixation methods are controversial. Surgical treatment is highly challenging.

To observe the clinical effect of lateral, anterolateral, and posterior olecranon osteotomy approaches in treating distal humeral coronal fracture and to explore the indications and precautions of different fracture types.

Twenty-three patients with distal humerus coronal fractures admitted to our hospital from January 2010 to January 2023 were selected as the study objects and divided into lateral, anterolateral, and posterior olecranon osteotomy groups according to different surgical approaches. The clinical effects were observed, including operation time, incision length, blood loss, fracture healing time, Elbow motion, forearm rotation, Mayo elbow performance score (MEPS) and visual analogue scale (VAS) score, and complications.

A total of 23 patients were diagnosed with a mean age of (48.9±17.0) years, a mean injury to surgery time of (5.1±2.0) days, and a mean follow-up time of (18.4±5.4) months. Significant differences existed between the three groups in the cause of injury and the modified Dubberley fracture classification. The three groups had no significant differences in operative time, fracture healing time, forearm pronation, forearm pronation MEPS, and VAS scores. There were statistically significant differences in blood loss, incision length, elbow flexion, extension, and ROM between the osteotomy and lateral groups. The osteotomy group had longer incisions, more surgical blood loss, and worse recovery of elbow motion. There was no significant difference between the osteotomy and anterolateral groups and between the lateral and anterolateral groups.

The lateral, anterolateral, and posterior olecranon osteotomy approaches for treating distal humeral coronal fractures have different indications, and the appropriate approach should be selected according to the fracture type. Fractures suitable for osteotomy approaches are more complex, and functional exercises should pay more attention to the recovery of elbow flexion and extension.