Early Functional Outcomes Following Distal Humerus Fracture Fixation Using the Triceps-Reflecting Anconeus Pedicle Approach Without Postoperative Immobilisation: A Retrospective Study of 33 Patients

Background: Distal humerus fractures require adequate articular exposure, stable fixation and early elbow mobilisation. The triceps-reflecting anconeus pedicle (TRAP) approach provides posterior exposure without olecranon osteotomy and may facilitate early rehabilitation while preserving extensor mechanism function. The purpose of this study was to report early functional outcomes, radiographic union, triceps function and complications after distal humerus fracture fixation using the TRAP approach without postoperative immobilisation.

Methods: This retrospective study reviewed 33 patients who underwent distal humerus fracture fixation using the TRAP approach at Kamphaeng Phet Hospital between January 2022 and December 2025. Demographic data, fracture characteristics, operative details, postoperative rehabilitation protocol, range of motion, Mayo Elbow Performance Score, triceps power, radiographic union and complications were reviewed. No postoperative elbow splint or cast was applied. Passive range-of-motion exercises were initiated 48 hours after surgery, while active elbow extension was restricted for 6 weeks.

Results: The mean age was 48.0 ± 17.8 years, and 23 patients were female. All injuries were related to motorcycle crashes. Twenty-seven fractures were closed, and six were open. The mean operative duration was 151.9 ± 49.5 minutes. The mean flexion–extension arc improved from 48.0° ± 17.0° at 2 weeks to 111.0° ± 17.0° at 24 weeks. At 24 weeks, the injured elbow achieved 82.2% ± 12.5% of the contralateral flexion–extension arc, with a mean side-to-side difference of 24.0° ± 15.0°. The mean final Mayo Elbow Performance Score was 81.8 ± 10.6. Radiographic union was achieved in 31 patients, with a mean union time of 16.8 ± 4.1 weeks. Complications occurred in eight patients, most commonly transient ulnar nerve paraesthesia, elbow stiffness and superficial wound infection. Some patients experienced more than one complication. No triceps rupture, implant failure or deep infection was observed.

Conclusions: Distal humerus fracture fixation using the TRAP approach without postoperative immobilisation showed acceptable early functional recovery and preserved triceps function in most patients. Early passive elbow motion beginning 48 hours after surgery may be feasible when stable fixation and secure triceps-anconeus repair are achieved.

Level of Evidence: Level IV (Therapeutic)