Comparison of two fixation techniques of olecranon osteotomy after reconstruction of intra-articular distal humerus fractures

Abstract

BACKGROUND

Accurate surgical fixation of intra-articular distal humerus fractures require olecranon osteotomy. Repair of osteotomy is achieved with a variety of techniques but no consensus has been achieved regarding the optimum technique for fixing the olecranon osteotomy. In this retrospective study, we compared the functional and radiological outcome of the two commonly used techniques of fixing olecranon osteotomy after fixing distal humerus intra-articular fractures. We hypothesized that olecranon osteotomy fixed with 6.5 mm cancellous intramedullary screw alone yielded better radiological and functional outcome than fixation with cerclage wire over cancellous screw applied in figure of eight as tension band wiring (TBW).

AIM

To determine the radiological and functional outcome of olecranon osteotomy fixation with cancellous screw alone vs cancellous screw combined with cerclage wiring applied as TBW.

METHODS

This retrospective study was conducted in Lady Reading Hospital Peshawar Pakistan. Intra-articular distal humerus fractures fulfilling the inclusion criteria and operated during 2023 to 2025 were included. Olecranon osteotomy fixation with 6.5 mm cancellous screw alone was labelled as group A while cerclage wire over cancellous screw in figure of eight as TBW were labelled as group B. The demographics, radiological and functional outcome in both groups were compared at one year using Mayo Elbow Performance Score and Quick Disabilities of the Arm, Shoulder, and Hand Score.

RESULTS

We included 32 patients in this study. The mean age of group A patients was 34 ± 5.5 years while group B had a mean age of 34 ± 6.2 years. Radiological union of olecranon osteotomy was achieved in all cases in both groups. Functional outcome however was significantly better in group A than in group B (P < 0.05). The Mayo Elbow Performance Score was excellent in 14 (87.5%) and good in 2 (12.5%) patients in group A while 7 (43.47%) patients had excellent outcome, 5 (31.25%) good and 4 (25%) had fair outcome in group B. The mean Quick Disabilities of the Arm, Shoulder, and Hand Score was 24.5 ± 2.1 and 78.1 ± 12.1 in group A and B respectively (P < 0.05).

CONCLUSION

Similar radiological union was achieved in all patients of olecranon osteotomy treated with intramedullary screw alone and intramedullary screw with TBW. Functional outcome however was significantly better in intramedullary screw alone than in intramedullary screw with TBW.

Keywords: Intra-articular distal humerus fractures; Olecranon osteotomy; Mayo Elbow Performance Score; Tension band wiring; Quick Disabilities of the Arm, Shoulder, and Hand

Core Tip: In this retrospective study, we compared the radiological and functional outcomes of the two commonly used techniques for fixing olecranon osteotomy after fixing intra-articular distal humerus fractures. Fixation of olecranon osteotomy with intramedullary cancellous screw and washer yielded significantly better functional outcome and minimal complications than intramedullary screw and tension band wiring in young patients.