Fixation of olecranon osteotomy only with 6′5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures

Abstract

Purpose The objective of this study is to demonstrate the safety and efficacy of the osteosynthesis with a 6.5 mm screw and washer of a Chevron shape olecranon osteotomy performed for the surgical approach of supraintercondylar fractures of the distal humerus, achieving union and complication rates better or similar to other published case series. Methods From 2009 to 2019, 26 patients underwent fixation of an olecranon osteotomy for the treatment of a supraintercondylar fracture of the distal humerus with partially threaded cancellous cannulated screws of 6.5 mm diameter with a washer. The patients were followed for at least 1 year, taking radiographs the day after the surgery, at 3, 6 and 12 months. Complications have been collected: infection, loss of reduction, non-union, delay of union, discomfort of the osteosynthesis hardware. The diameter of the ulna medullary canal diaphysis was also measured in all patients. Results Consolidation of the osteotomy was 100% at 12 months. The average time of radiological consolidation was 112 ± 12 days. The average size of the ulna medullary canal diaphysis was 6′06 ± 0′16 mm on anteroposterior radiographs and 5′65 ± 0′14 mm on lateral radiographs. The mean screw length was 102′31 mm ± 3′89. We found 1 acute infection, 2 osteotomies delays of union (one of these cases was the acute infection case), one early osteosynthesis failure and 1 wound dehiscence. Conclusions Olecranon ostetomy fixation with a 6′5 mm cancelous partial threaded screw and washer is safe and effective with a high consolidation rate and excellent results and with complication rates similar to or lower than other fixation methods published. Long enough screws must be used to get a good cortical grip with enough stability. Level of evidence Level IV, Case series, retrospective review.

Techniques and Fixation of Olecranon Osteotomy: A Systematic Review

“…Five studies did not report an average follow-up time period but rather included a minimum follow-up time period for patients included in their study. 7 , 11 , 13 , 17 , 18…”

“… 5 , 6 Newer techniques use a long, fully, or partially threaded cancellous screw (with or without a washer) spanning the osteotomy site. 7 Adding a stainless-steel wire in a figure-of-eight configuration (ie, a tension band) to the single cancellous screw has the benefit of additional compression at the osteotomy site. The use of plate and screw constructs is becoming more common, likely due to the low-profile nature of newer plates and the strength of locking screw constructs.…”

Plate vs. intramedullary screw fixation of chevron olecranon osteotomies: a biomechanical study

“…In a case series of 26 patients who underwent IMSF of an olecranon osteotomy with a 6.5 mm screw and a washer, there was a 100% union rate at 1 year postoperatively, with 2 cases of delayed osteotomy consolidation. 6 Similarly, in a retrospective study that included 18 patients who underwent PF and 10 with IMSF, 1 patient in the PF group went on to nonunion with revision PF and subsequent union, while there was a 100% union rate in the IMSF group. 20 However, there is a lack of studies comparing patient-reported outcomes between PF and IMSF.…”

“…Recent clinical studies highlight the possible advantages of intramedullary screw fixation (IMSF) compared to plate or tension band constructs, notably the minimal tissue dissection and lack of hardware prominence, which might confer lower rates of wound healing complications and reoperation. 5 , 6 , 19 Intramedullary screw fixation is also an attractive option due to its relative simplicity compared to the more technical and time-consuming tension band or plate and screw constructs.…”

Treatment of Supracondylar Humerus Fracture in Adults by Parallel Plates

“…Open reduction and internal fixation with plates with good articular reconstruction have demonstrated satisfactory clinical outcomes. Firm stabilization can be achieved through various methods of fixation of plates (9)(10)(11) . Among them, several mechanical studies have proved that double plate fixation provides more stable fixation than other methods (12)(13)(14) .…”