Designing of a Distal Humerus Anatomical Biplanar Locking Fixation Plate.

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Abstract

Conflict of interest statement: Conflict of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest. 10. Orthop Traumatol Surg Res. 2021 Apr;107(2):102641. doi: 10.1016/j.otsr.2020.02.022. Epub 2020 Oct 29. Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures. Dumartinet-Gibaud R(1), Lancigu R(2), De Sainte Hermine P(3), Cronier P(2), Hubert L(2), Rony L(2); la Société d’Orthopédie de l’Ouest (SOO)(4). Author information: (1)Service de chirurgie orthopédique, CHU d'Angers, 4, rue Larrey, 49000 Angers, France. Electronic address: raphaelle.gibaud@gmail.com. (2)Service de chirurgie orthopédique, CHU d'Angers, 4, rue Larrey, 49000 Angers, France. (3)Polyclinique du Parc, avenue des Sables, 49300 Cholet, France. (4)SOO, 18, rue de Bellinière, 49800 Trélazé, France. 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. LEVEL OF EVIDENCE: IV. Copyright © 2020 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2020.02.022