Evaluation and Experience in the Treatment of Coronal Plane Elbow Fractures via the Anterior Approach

Background: The existing approaches to treating elbow fractures include anterior, external, internal, and posterior approaches. Of these, the anterior approach is often not chosen by surgeons to avoid damaging important nerves and blood vessels. In fact, the anterior approach has unique advantages. The purpose of this study was to report the outcomes in 38 patients with coronal plane elbow fractures treated through the anterior approach. Methods: : We retrospectively analyzed 38 cases of coronal plane elbow fractures treated through an anterior approach at our institution between March 2015 and July 2019. The length of the surgical incision, operation time, intraoperative blood loss, and postoperative complications were recorded. The range of flexion, extension, and rotation of the affected elbow and the healthy elbow were collected at follow-up. Functional outcomes were evaluated using the Mayo Elbow Function Score (MEPS). Results: : All 38 patients were followed up. At the final follow-up, solid osseous union was confirmed for all coronal plane elbow fractures. The mean elbow flexion arc was 129.26 ± 6.9 degrees, and the extension arc was 8.87 ± 6.13 degrees. The mean pronation arc was 83.45 ± 2.9 degrees, and the supination arc was 80.05 ± 2.92 degrees. The mean MEPS was 90.0±7.53 points, with 18 excellent cases and 20 good cases. There was no significant difference in elbow extension, flexion, and pronation between 31 cases of single fracture and the healthy elbow ( P > 0.05); the arc of supination was slightly worse than that of the healthy elbow ( P < 0.05). The VAS pain scores of the patients before the operation, three months after the operation, and during follow-up were compared. The pain of the patients was significantly reduced after treatment ( P < 0.05). Two patients experienced transient postoperative median nerve paralysis, from which they recovered within three months. One patient had mild heterotopic ossification and was not treated because it did not affect the function of the elbow joint. All patients returned to work and were satisfied with the treatment. Conclusion: The anterior approach has the benefits of simplicity, safety, minimal invasion, excellent exposure, and satisfactory prognosis for coronal plane elbow fracture.