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Bryan-Morrey Approach: A Safe Approach for Intra-Articular Fractures of Distal Humerus
Keywords:
Bryan-Morrey, Fracture, Intercondylar humerus, Mayo Elbow Performance Index, Olecranon osteotomy.Abstract
Objective: To determine the functional outcome of open reduction and internal fixation (ORIF) of intra-articular distal humerus fractures treated with Bryan Morrey approach.
Methods: This descriptive was conducted in Department of Orthopaedics Abbasi Shaheed Hospital Karachi from 1st January 2018 to 31st December 2019. All patients with intra-articular distal humerus fractures fulfilling the inclusion criteria were included. Open reduction and internal fixation was carried out in all patients using Bryan-Morrey approach. Functional outcome was assessed with Mayo Elbow Performance Index(MEPI) at the end of one year and graded as excellent (MEPI score 90 to 100 points),good(75-89),fair(60-74) and poor(<60).Stratification of data based upon age, gender, type of fracture and time since fixation was done and post stratification comparison of functional outcome was done.Chi square test was applied and P value calculated( P value < 0.05 was considered significant)
Results: We operated 35 patients of intra-articular distal humerus fracture with Bryan Moorey approach. Male patients were 23(65.8%) and female 12(34.3%). Mean age was 43.8±13.31(range 20 to 65) years. Right humerus was fractured in 21(60%), left in 10(28.6%) and bilateral in 4(11.4%). AO 31C1 fractures were noted in 10(28.6%) patients,31C2 in 15(42.9%) and 31C3 in 10(28.6%) patients. Excellent functional outcome was observed in 13 (37.1%) patients, good in 14 (40%), fair in 6 (17.1%) and poor in 2 (5.7%) patients. No statistically significant difference was found in functional outcome of male and female patients, different types of fractures and age below 40 years versus above 40 years(P value >0.05).However fractures fixed within 4 days of sustaining fractures showed better functional outcome than those fixed late(P value <0.05).No major complication reported.
Conclusion: Excellent and good functional outcomes were achieved in majority of our patients of intra-articular distal humerus fractures fixed with Bryan-Morrey approach. We therefore recommend Bryan-Morrey approach as a technique of first choice for all intra-articular distal humerus fractures.
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