Plate fixation of olecranon osteotomies

The management of intra-articular distal humeral fractures remains a difficult surgical problem. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a number of complications can occur after the creation and repair of the osteotomy including nonunion, malunion, hardware failure, and pain secondary to prominent hardware. In an effort to reduce the incidence of these complications, the senior authors now use contoured 3.5 mm reconstruction plates for the fixation of their apex-distal chevron olecranon osteotomies. Two surgeons at a single institution used this technique of exposure on a series of 17 consecutive patients with intra-articular distal humerus fractures between 1996 and 1999. In this series, all osteotomies united. There was one complication related specifically to the osteotomy: one of the screws in the plate penetrated the proximal radioulnar joint, interfering with forearm rotation; a second procedure was required to shorten the screw. Only one of the 17 patients requested plate removal during the 32 month (average) follow-up period. Plate fixation of olecranon osteotomies using a 3.5 mm reconstruction plate provides a construct with predictable healing and few complications. The overall results using this technique are comparable with other reported methods in the literature.