Mini-fragment plate fixation after olecranon osteotomy for distal humerus fractures

Purpose: Although olecranon osteotomies are helpful for distal humerus visualization, traditional methods of fixation are commonly irritating for patients and require hardware removal. Recent studies have shown lower hardware removal rates for medullary screw constructs and 3.5-mm plates, but no studies have investigated the use of 2.7-mm plates for olecranon osteotomy fixation. The purpose of this study is to report on the outcomes of single 2.7-mm mini-fragment plate fixation of olecranon osteotomies for distal humerus intra-articular fractures.

Methods: Patients who sustained an intra-articular distal humerus fracture, as identified by Current Procedural Terminology codes, were reviewed retrospectively over a 5-year study period (2016-2020) at a single level 1 trauma center after institutional review board approval. Only patients who underwent an olecranon osteotomy for distal humerus visualization during their definitive operation and that was subsequently fixed with a single 2.7-mm plate were included. Primary outcomes were implant removal and osteotomy union. Secondary outcomes included indications for implant removal, implant failure, infection, and revision surgery. Hardware removal rates were compared to historically reported rates in the literature. χ² vs. Fisher exact tests were used to compare fixation groups based on number of patients in each cohort (5 or less was used for the cutoff for Fisher exact test).

Results: Thirty-eight patients were included in the final analysis. The average age was 50 years (standard deviation [SD] 18), 58% (22 patients) were female, and the average follow-up time was 9.7 months (SD 5). All patients with mini-fragment plate fixation went on to union of their olecranon osteotomy. Three patients (7.8%) had their olecranon hardware removed for all causes: 1 for revision open reduction and internal fixation (ORIF), 1 for irritation, and 1 removal during concomitant capsulectomy and manipulation. There was a 21% (8 patients) revision surgery rate in the cohort but only 3 of those were for issues related to the olecranon osteotomy. One patient required revision ORIF of the olecranon osteotomy for hardware loosening. Compared with other fixation constructs, mini-fragment plates had a lower removal rate than tension band wiring (P = .0002) and 3.5-mm plates (P = .05) and similar among medullary screws ± wires. Nonunion rates were similar between all constructs (P = .07).

Conclusion: Single 2.7-mm mini-fragment plate fixation of olecranon osteotomies for distal humerus fractures is safe and effective with low rates of revision, hardware removal, and nonunion. This type of fixation should be considered when treating intra-articular distal humerus fractures that require an olecranon osteotomy.