J Korean Fract Soc.  2015 Apr;28(2):118-124. 10.12671/jkfs.2015.28.2.118.

Cannulated Screw and Wire Fixation with Predrilling for Olecranon Osteotomy in Intra-articular Comminuted Distal Humerus Fractures

• Han SH
• Lee HJ
• Kim WH
• Jo YG
• Song WT

• KMID: 2044019
• DOI: http://doi.org/10.12671/jkfs.2015.28.2.118

Abstract

PURPOSE
The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus.
MATERIALS AND METHODS
This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated.
RESULTS
All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem.
CONCLUSION
Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra-articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.

Keyword

Intra-articular fractures; Osteotomy; Olecranon process; Humerus; Elbow

MeSH Terms

Elbow
Female
Follow-Up Studies
Humans
Humerus*
Intra-Articular Fractures
Olecranon Process*
Osteotomy*
Postoperative Complications
Retrospective Studies

Figure

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  Fig. 1 Operative techniques of olecranon osteotomy. (A) Midline incision with curve over the olecranon. (B) Predrilling for cannulated screw fixation after guide pin insertion. (C) Distally oriented chevron osteotomy with a predrilled hole (arrow). (D) Stabilization of fracture. (E) Reduction of osteotomized olecranon with insertion of predrilled guide pin. (F) Fixation with partially threaded 7.0 mm cannulated screw and a washer. (G) Wiring in a figure 8 pattern.

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  Fig. 2 Postoperative radiographs. (A) Antero-posterior view. (B) Lateral view.

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  Fig. 3 (A) Undisplaced ulnar shaft fracture is seen adjacent to the screw tip. (B) Fracture is healed after conservative treatment.

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