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Olecranon Osteotomy in Distal Humerus Fixation and Associated Non-Union Rates
Xavier M Torres, BS
1, Nikalus Skipp, BS
1, Evan Kiesel, BS
1, Ann L Wells, PhD
1; Deana Mercer, MD
2(1)University of New Mexico School of Medicine, Albuquerque, NM, (2)University of New Mexico, Albuquerque, NM
Introduction: Distal humerus fractures which are comminuted with articular extension, may require the utilization of an olecranon osteotomy to visualize the articular surface and allow anatomical and stable reduction. This study examines fixation techniques from 2002-2024 and outcomes of olecranon osteotomies at a single institution to assess for reoperation and nonunion rates with varying fixation techniques.
Materials & Methods: A retrospective chart review was conducted of distal humerus fractures with simultaneous olecranon osteotomies treated at a single level 1 trauma institution. Reoperation and nonunion rates were compared across olecranon osteotomy approaches to see efficacy of olecranon osteotomy fixation techniques. Indications for reoperation includes hardware irritation, infection, nerve injury, and nonunion.
Results: We reviewed 102 distal humerus fractures treated with an olecranon osteotomy for exposure. At our institution, osteotomy fixation prior to 2008 was most often achieved with tension-band-wiring and single cannulated screws, but after 2008, there was increased utilization of olecranon plates with an institutional shift to all olecranon plates after 2021. 42.1% of osteotomies were repaired using an olecranon plate, 30.4% using tension band wiring (TBW), 11.8% using a single cannulated screw and washer, and 15.7% using a cannulated screw, washer, and sternal wiring. Within the cohort, 29.4% of osteotomies required reoperation due to factors such as hardware irritation, infection, nerve injury, or nonunion. 46.7% of the reoperations involved hardware removal due to irritation despite having fully healed osteotomy sites. The nonunion rate of osteotomy sites was 5.88% within the cohort with varying rates based on the fixation method utilized. The olecranon plate group had a nonunion rate of 0%, while tension band wiring (TBW) had a nonunion rate of 9.68%, single cannulated screw with a washer had a nonunion rate of 8.33%, and a cannulated screw with a washer and sternal wiring had a nonunion rate of 12.5%. Fisher's exact tests comparing olecranon plates to all other fixation methods revealed a statistically significant association with reoperation in the non-plated group (p = 0.0157) and increased nonunion in the non-plated group (p = 0.038).
Conclusions: These results show if an olecranon osteotomy is used for articular visualization of a distal humerus fracture, the fixation method with the lowest need for reoperation and least likelihood for nonunion was the olecranon plate. Tension-band-wiring, single cannulated screw with a washer, and single cannulated screw with a washer and sternal wire all showed statistically significant higher rates of reoperation and nonunion.
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