Objective To compare the efficacy and safety of internal fixation using the olecranon osteotomy approach ver-sus the bilateral triceps approach for the treatment of AO type C distal humeral fractures.Methods We conducted a systematic search of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,Chinese Medical Journal Full-Text Database,PubMed,Embase,Web of Science,and Cochrane Library for clinical studies comparing the olecranon osteotomy approach with the bilateral triceps approach for the treatment of AO type C distal humeral fractures.The search period was from January 2017 to March 2023.A meta-analysis was performed on the included studies.Random-effects models were used for analyses with high inter-group het-erogeneity,while fixed-effects models were applied for those with low inter-group heterogeneity.Results A total of 15 studies were included in the meta-analysis,comprising 480 cases treated via the olecranon osteotomy approach and 443 cases via the bilat-eral triceps approach.Meta-analysis results showed that the olecranon osteotomy approach was associated with longer operative time[SMD=0.96,95％CI(0.23,1.70),P=0.010]and more intraoperative blood loss[SMD=1.00,95％CI(0.22,1.78),P=0.012]compared to the bilateral triceps approach.There were no statistically significant differences between the two groups in postopera-tive Mayo Elbow Performance Score[SMD=0.55,95％CI(-0.23,1.32),P=0.167],excellent and good reduction rate[OR=0.98,95％CI(0.75,1.27),P=0.856],postoperative complication rate[OR=1.27,95％CI(0.77,2.09),P=0.344],healing time[SMD=-0.13,95％CI(-0.37,0.11),P=0.280],and range of motion of the elbow joint[SMD=-0.02,95％CI(-0.29,0.26),P=0.891].Conclusion The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach.The bilateral triceps approach for internal fixation of AO type C distal humeral fractures is associated with shorter operative time and lower intraoperative blood loss compared to the olecranon osteotomy approach.
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