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

Soo-Hong Han; Ho-Jae Lee; Woo-Hyun Kim; Yong-Gil Jo; Won-Tae Song

doi:10.12671/jkfs.2015.28.2.118

Journal List > J Korean Fract Soc > v.28(2) > 1038020

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Han, Lee, Kim, Jo, and Song: Cannulated Screw and Wire Fixation with Predrilling for Olecranon Osteotomy in Intra-articular Comminuted Distal Humerus Fractures

Original Article

Journal of the Korean Fracture Society 2015; 28(2): 118-124.

Published online: 21 April 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.2.118

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

Soo-Hong Han, M.D., Ph.D., Ho-Jae Lee, M.D., Woo-Hyun Kim, M.D., Yong-Gil Jo, M.D., Won-Tae Song, M.D.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Address reprint requests to: Soo-Hong Han, M.D., Ph.D. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea. Tel: 82-31-780-6074, Fax: 82-31-708-3578, hsoohong@cha.ac.kr

Received 19 December 2014 Revised 18 February 2015 Accepted 6 March 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Intra-articular fractures, Osteotomy, Olecranon process, Humerus, Elbow

Figures and Tables

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.

Fig. 2

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

Fig. 3

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

Table 1

Summary of Cases

Notes

^{Financial support} None.

^{Conflict of interest} None.

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