Introduction: Approximately, 7% of all adult fractures involve the elbow, of these approximately, one third (2%) are distal humeral fractures. Articular fractures of elbow are the most difficult one to treat. Currently the olecranon osteotomy approach is the most commonly used. O’Driscoll has described a triceps reflecting anconeous pedicle approach (TRAP) that avoids an osteotomy.

Objectives: To evaluate and compare the results of TRAP approach and olecranon osteotomy approach in open reduction internal fixation of supracondylar intercondylar fracture of humerus in term of Mayo Elbow Performance Score.

Methodology: The present study was a comparative interventional study on patients with intercondylar fracture of humerus admitted in department of Orthopaedics, S.M.S. Hospital, Jaipur during Jan 2012 to Oct 2013. Total 36 patients were taken, out of them 18 were in group-A (operated by olecranon osteotomy approach) and 18 were in group-B (operated by TRAP approach).

Results: Duration of surgery was considerably more in group B (1.36 ±. 067 hours) compare to group-A (1.26 ±. 096 hours). That was statistically significant. Mean duration for fracture union in group-A was 13.56 ± 2.007 weeks, while it was 12.56 ± 1.504 weeks in group-B. There was no statistically significant difference. Average of flexion was 110.56 ± 18.86 degrees and 112.78 ± 21.91degrees in group-A and group-B respectively shows there was no significant difference between two groups flexion. Average of extension lag was 19.72 ± 14.70 degree in group-A and it was 12.22 ± 11.90 degree in group-B shows there was no statistically significant difference between two groups extension lag. The mean elbow arc of motion in group A was 90.83 ± 30.35 degrees and in group B was 100.56 ± 28.28 degrees. There was no statistically significant difference. We observed that 3 patients of group-A and 1 patient of group-B had superficial infection during first 2 weeks after surgery. One patient of group-A had deep infection.

The average Mayo Elbow Performance Score in group-A was 84.17 ± 16.382 and in group-B was 87.78 ± 14.061. P-value was >.05 (0.483) show that there was no statistically significant difference between two groups MEPS. Overall 29 patients (80.55%) out of 36 shown excellent and good results with conclusion that there is no statistically significant difference between results of two groups.

Conclusion: TRAP approach is comparatively better than osteotomy approach. TRAP approach allows stable Fracture fixation, with the advantage of intact olecranon. The approach permits aggressive postoperative elbow rehabilitation.