Background:
Humerus supracondyllar fracture is one of the most common elbow injuries. Choice of treatment depends on grading ofthe displacement. Closed Reduction and pinning is the preferred method of treatment. Open reduction is indicated when we encounterneurovascular injury after closed reduction. One of the most important factors in the outcome of surgery is an appropriate approach thatwould provide better exposure with less soft tissue injury. Anterior, posterior, medial and lateral surgical approaches are used for this typeof fracture. Objectives: Posterior bilateral triceps approach has less been studied so far. In this study we review the results of humerus supracondyllarfracture surgery by this approach. Patients and Methods: This study is a case series and includes 43 patients aged between 3.5-15 who referred to Imam Reza Hospital inMashhad Iran from July 2006 to Octobre 2011 with humeral supracondylar fracture; Gartrland; type III. All patients had at least once, failedclosed reduction. On admission, all patients with open fracture or neurovascular injury were excluded. All the patients were operatedin one hospital and with the same method (bilateral triceps open reduction). Patients were followed up from 7 months to 2 years by theclinicians who were not involved in the selection of patients, the process of treatment and surgery. History, basic information, DASHquestionnaire (disability of the arm and hand) physical clinical examination, particularly ROM (range of motion) and objective tests tomeasure muscular strength and radiographies were reviewed. Results: The mean age was 7.2 ± 2.4 years. The mechanisms of injuries were falling in 25 patients, skateboarding accident in 6 patientsand 12 cases of motorized or non-motorized vehicle accidents. 8 patients required physiotherapy (maximum 20 sessions). Joint ROM in91% of patients was complete. 4 patients (9%) had about 5-10 degree of limited range of extension (flexion deformity). The mean elbowflexion and extension strength in the injured hand was 80%-95% of the opposite one. No instability and laxity of the elbow joint was seen.The mean score of DASH was 30 ± 2.4. Reduction in the X-ray control after surgery was acceptable. No loss of reduction, nonunion andmalunion, hardware failure, wound and infection complications, bleeding from the wound or hematoma formation at the site of surgery,neurological disorders after surgery and paresis were seen in postoperative examinations. Conclusions: By using Bilateral triceps approach for humerus supracondylar fracture, you can be able to have a very good exposurefield as presented on pictures and due to less soft tissue damage in this approach, you need less immobilization time. After six weeks, thepatient has full elbow range of motion, acceptable DASH score and no complication.