Outcome differences of olecranon osteotomy versus triceps-reflecting anconeus pedicle approach: A systematic review and meta-analysis

Distal intercondylar humerus fractures are classified as intra-articular and comminuted fractures with soft tissue injuries that is consider as complex and difficult to treat. Choice of management may as well be performed surgically with open reduction and internal fixation with the olecranon osteotomy technique as the current gold standard. However, there is another option for fixing the fractures using triceps reflecting anconeus pedicle (TRAP) that preserves anconeus nerve supply but still allows proper exposure to the distal humerus. This study compares the outcome between olecranon osteotomy and TRAP. Using PRISMA guidelines, publications were searched in online databases from January 1st, 2010, to January 1 st , 2025, using Boolean operators and screened according to predefined inclusion and exclusion criteria. Outcomes were MEPS, DASH, the mean elbow arc of motion, and the complication rate. A total of 1187 records were identified, and 8 studies were included in qualitative and quantitative analyses. Analysis was conducted using RevMan. Functional outcomes measured by MEPS and DASH did not differ significantly between the two approaches (MD: -2.09; 95% CI: -6.04 1.86; P= 0.30 and MD: −0.57; 95% CI: −4.64 to 3.50; P=0.78, respectively). Mean elbow arc of motion was significantly better in the TRAP group (MD = 4.83; 95% CI: 1.94 to 7.73; P =0.001; I2 = 14%). Overall complication rate was also lower in the TRAP group (OR: 0.40; 95% CI: 0.19 to 0.85; P=0.02; I 2 =0%). From the study, outcomes of the technique are still comparable, depending on the configuration of the fracture, how much exposure is needed by the surgeon's preferences, and whether the technique will be used. Further studies will be needed in order to create more satisfying results to compare which technique is better than another.