PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.

• MeSH
• Algorithms MeSH
• Humeral Fractures * surgery   MeSH
• Humerus MeSH
• Humans MeSH
• Olecranon Process * MeSH
• Range of Motion, Articular MeSH
• Fracture Fixation, Internal * MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Surgical Procedures, Operative methods   MeSH
• Humeral Fractures surgery   physiopathology   therapy   MeSH
• Fractures, Bone * surgery   classification   complications   physiopathology   therapy   MeSH
• Ulna Fractures surgery   physiopathology   therapy   MeSH
• Radius Fractures surgery   physiopathology   therapy   MeSH
• Humerus physiopathology   injuries   MeSH
• Bone and Bones physiopathology   injuries   MeSH
• Bones of Upper Extremity physiopathology   injuries   MeSH
• Elbow Joint * surgery   physiopathology   MeSH
• Joint Instability * surgery   physiopathology   therapy   MeSH
• Olecranon Process surgery   physiopathology   injuries   MeSH
• Orthopedic Procedures methods   adverse effects   MeSH
• Elbow Injuries MeSH
• Arm Injuries surgery   complications   therapy   MeSH
• Forearm Injuries surgery   physiopathology   therapy   MeSH
• Forearm physiopathology   MeSH
• Joint Prosthesis MeSH
• Pseudarthrosis surgery   therapy   MeSH
• Radius physiopathology   injuries   MeSH
• Ulna physiopathology   injuries   MeSH
• Fracture Fixation, Internal methods   adverse effects   MeSH

PURPOSE OF THE STUDY Olecranon fractures in skeletally immature patients are rather rare and represent up to 7% of elbow skeletal injuries. Although the majority of olecranon fractures is constituted by undisplaced fractures treated conservatively with good outcomes, a few of them require surgery. The aim of the study was to compare two different approaches of surgical treatment - the open reduction with tension band wiring - cerclage (ORCe) and the closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS 37 patients (28 boys, 9 girls) were included in the retrospective multicentric study. The patients were treated at two different institutions (the Clinic of Paediatric Surgery, Orthopaedics and Traumatology, the University Hospital Brno and the Department of Paediatric Surgery and Traumatology, the University Hospital Hradec Králové, Czech Republic). 17 patients underwent the ORCe procedure, while 20 patients were treated using the CRPP method. Different parameters were statistically compared in the groups (demographic data, data concerning the course of the therapy, outcome of the therapy in terms of movements' restrictions and complications such as osteosynthesis failure and infection). RESULTS Both the groups were comparable in terms of demographic data because no statistically significant difference was observed in terms of the age (p = 0.082), the affected site (p = 1.000) and the gender (p = 0.462). Statistically significant difference between these two groups was found in the interval between the implementation and the removal of the osteosynthetic material (p < 0.001) and in the length of cast immobilisation (p = 0.047). The number of patients with movement restriction up to 10° was statistically significantly higher in patients who underwent the CRPP procedure (p = 0.040), but no statistically significant difference was seen between these two groups in terms of movement restriction more than 10° (p = 0.609). One revision surgery was performed in the CRPP group, however with no statistical significance (p = 0.350). DISCUSSION The multicentric study included 37 children, who underwent surgical treatment of a displaced olecranon fracture. Compared to the studies dealing with this topic the number of patients included in this study is relatively high. It advocates the possibility of using the CRPP method as a good alternative to the gold-standard ORCe technique because no difference in terms of the number of revision surgeries and the clinically important movement restriction of more than 10° were seen. It also brings along advantages such as a simple surgical technique, good functional and cosmetic effects, reducing the risk of ischemic insult of growth plate and the possibility of osteosynthetic material removal at an outpatient department with no need for general anaesthesia. The risk of a higher radiation exposure of both the patient and the surgical team should be considered as a disadvantage of the closed method. CONCLUSIONS The mini-invasive CRPP appears to be a good alternative option to the ORCe method for the treatment of isolated olecranon fractures in children offering the advantages such as avoiding extensive open procedure and simple implants removal. Key words:children, olecranon, fracture, tension band wiring - cerclage, percutaneous pinning, elbow.

• MeSH
• Child MeSH
• Humeral Fractures diagnosis   surgery   MeSH
• Outcome Assessment, Health Care MeSH
• Bone Wires MeSH
• Humans MeSH
• Elbow Joint * diagnostic imaging   surgery   MeSH
• Olecranon Process * diagnostic imaging   injuries   surgery   MeSH
• Open Fracture Reduction * adverse effects   instrumentation   methods   MeSH
• Elbow Injuries MeSH
• Radiography methods   MeSH
• Comparative Effectiveness Research MeSH
• Closed Fracture Reduction * adverse effects   methods   MeSH
• Age Factors MeSH
• Patient Selection MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

• Keywords
• Boutonnierova deformita,
• MeSH
• Early Ambulation MeSH
• Chronic Disease MeSH
• Hand Deformities * surgery   classification   physiopathology   rehabilitation   MeSH
• Adult MeSH
• Ulna Fractures * surgery   complications   therapy   MeSH
• Finger Joint surgery   physiopathology   MeSH
• Conservative Treatment MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Olecranon Process * diagnostic imaging   physiopathology   MeSH
• Finger Injuries etiology   surgery   physiopathology   MeSH
• Prospective Studies MeSH
• Randomized Controlled Trials as Topic MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Overall MeSH
• Comparative Study MeSH

Elbow injuries continue to rise with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in specific diagnosis, and therapy. The surgical treatment of trauma to the adult elbow has evolved rapidly in recent years and many useful concepts and techniques have been established. This paper reviews the published scientific data and current opinion available to guide patient care.

• MeSH
• Humeral Fractures diagnosis   surgery   complications   therapy   MeSH
• Ulna Fractures diagnosis   surgery   therapy   MeSH
• Haplosporida MeSH
• Humans MeSH
• Elbow Joint surgery   MeSH
• Olecranon Process injuries   MeSH
• Elbow Injuries MeSH
• Fracture Fixation, Internal methods   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• Keywords
• invazívní mykotická onemocnění,
• MeSH
• Amphotericin B * administration & dosage   MeSH
• Child MeSH
• Echinocandins * administration & dosage   MeSH
• Humans MeSH
• Precursor T-Cell Lymphoblastic Leukemia-Lymphoma * drug therapy   complications   MeSH
• Mucormycosis * etiology   drug therapy   surgery   MeSH
• Olecranon Process * microbiology   pathology   drug effects   MeSH
• Antineoplastic Combined Chemotherapy Protocols administration & dosage   immunology   adverse effects   MeSH
• Recurrence * MeSH
• Rhizopus * isolation & purification   classification   drug effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH