European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
Clinical outcomes following Triceps-Reflecting Anconeus pedicle (TRAP) approach for treating intercondylar distal humerus fractures: A systematic review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Yazdanpanah Shahabeddin, Gooch Braeden R, Cyrus John W, Cassidy Benjamin P, Smith Matthew S, Satalich James R, Vanderbeck Jennifer L
Аннотация
PURPOSE: Distal humerus fractures (DHFs) constitute 2% of all fractures, with open reduction and internal fixation (ORIF) often indicated for treatment. Within ORIF literature exists the triceps-reflecting anconeus pedicle (TRAP) approach: an alternative that offers adequate exposure while preserving key soft-tissue structures hypothesised to improve outcomes. Despite this, TRAP-related findings remain poorly collated and lacking consensus. Thus, this systematic review aims to synthesise TRAP-utilising intercondylar DHF ORIF outcomes to guide and inform surgical decision-making.
METHODS: A PROSPERO-pre-registered query searched PubMed, Ovid-Embase, Cochrane, and Web of Science on June 26th, 2025, for relevant studies. Demographics, range-of-motion (ROM), and complications were among extracted variables. Frequency-weighted means (FWM) and standard deviations, supplemented by narrative synthesis, constituted data analyses.
RESULTS: Twelve moderate quality observational studies were included (n = 295; 59.6% male; FWM age 38.7 ± 10.8 years; follow-up 26.1 ± 9.5 months). All patients underwent TRAP approach DHF ORIF for AO type C fractures (C1 = 29.4%; C2 = 40.7%; C3 = 29.9%), most often from falls or motor vehicle accidents. Union was reported in all cases, and at a FWM 15.7 ± 4.7 weeks. FWM Flexion-extension arc was 113.8˚ ± 12.3, prosupination arc was 157.9˚ ± 8.1, and Mayo Elbow Performance Score was 85.5 ± 8.3. The pooled complication rate was 26.5%, with ulnar nerve-related issues (8.8%) and infection (8.5%) most frequent.
CONCLUSION: The TRAP approach to DHF ORIF appears to yield favorable union, ROM, and functional outcomes; however, ulnar nerve-related issues and infection warrant relative caution. Future large, randomised trials are needed to better optimise alternative surgical approach selection strategies.
LEVEL OF EVIDENCE: Level III.
METHODS: A PROSPERO-pre-registered query searched PubMed, Ovid-Embase, Cochrane, and Web of Science on June 26th, 2025, for relevant studies. Demographics, range-of-motion (ROM), and complications were among extracted variables. Frequency-weighted means (FWM) and standard deviations, supplemented by narrative synthesis, constituted data analyses.
RESULTS: Twelve moderate quality observational studies were included (n = 295; 59.6% male; FWM age 38.7 ± 10.8 years; follow-up 26.1 ± 9.5 months). All patients underwent TRAP approach DHF ORIF for AO type C fractures (C1 = 29.4%; C2 = 40.7%; C3 = 29.9%), most often from falls or motor vehicle accidents. Union was reported in all cases, and at a FWM 15.7 ± 4.7 weeks. FWM Flexion-extension arc was 113.8˚ ± 12.3, prosupination arc was 157.9˚ ± 8.1, and Mayo Elbow Performance Score was 85.5 ± 8.3. The pooled complication rate was 26.5%, with ulnar nerve-related issues (8.8%) and infection (8.5%) most frequent.
CONCLUSION: The TRAP approach to DHF ORIF appears to yield favorable union, ROM, and functional outcomes; however, ulnar nerve-related issues and infection warrant relative caution. Future large, randomised trials are needed to better optimise alternative surgical approach selection strategies.
LEVEL OF EVIDENCE: Level III.