Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures - 29/10/20

Doi : 10.1016/j.otsr.2020.02.022

Raphaëlle Dumartinet-Gibaud ^a,⁎ , Romain Lancigu ^a, Pierre De Sainte Hermine ^b, Patrick Cronier ^a, Laurent Hubert ^a, Louis Rony ^a
et
la Société d’Orthopédie de l’Ouest (SOO)^c
^a Service de chirurgie orthopédique, CHU d’Angers, 4, rue Larrey, 49000 Angers, France
^b Polyclinique du Parc, avenue des Sables, 49300 Cholet, France
^c SOO, 18, rue de Bellinière, 49800 Trélazé, France

^⁎Corresponding author at: Service de chirurgie orthopédique, CHU d’Angers, 4, rue Larrey, 49000 Angers, France.Service de chirurgie orthopédique, CHU d’Angers4, rue LarreyAngers49000France

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Abstract

Introduction

Supra- and intercondylar elbow fractures are surgically challenging given the intra-articular comminution. Various surgical approaches have been described. Among these–olecranon osteotomy–provides optimal joint exposure but is associated with several complications. Tension band wiring (TBW) is the most commonly used fixation method. We hypothesized that double screw fixation would lead to fewer surgical revisions than TBW (all causes included) after olecranon osteotomy.

Methods

We carried out a single-center retrospective study of 39 patients, treated between January 2007 and April 2016, for a supra- or intercondylar elbow fracture using the transolecranon exposure. There were 34 type C fractures (13 C1, 6 C2 and 15 C3), 3 type B fractures and 2 type A fractures, based on the AO classification. Fourteen patients received double screw fixation and 25 received TBW. The primary outcome measure was the number of surgical revisions, regardless of cause. Secondary outcome measures were the number of surgical revisions for olecranon nonunion, fixation failure or fixation device removal due to pain.

Results

There were significantly more surgical revisions in the TBW group than in the double screw fixation group: 3 (21%) versus 14 (56%) (p=0.049, Fisher test). The three main reasons for revision in the TBW and double screw fixation groups were removal of the fixation device due to soft tissue impingement (11 [44%] versus 2 [14%]; p=0.08), failure of the olecranon fixation (6 [24%] versus 1 [7%] p=0.38), and olecranon nonunion (4 [16%] versus 0 [0%] p=0.27).

Discussion

There are no published studies on the outcomes of this surgical technique. The posterior transolecranon approach provides the best exposure at the elbow joint. TBW fixation is associated with multiple complications. Double screw fixation for olecranon fractures yields good clinical and radiological outcomes.

Conclusion

Based on our findings, double screw fixation of the olecranon results in fewer surgical revisions (all causes combined) than TBW in supra- and intercondylar elbow fractures operated by a transolecranon approach.