Fixation of Olecranon Fractures and Osteotomies Using Compression Screws: A simple Solution to a Common Problem. A Study of Cases

Abstract

Olecranon fractures are common skeletal injuries accounting for approximately 10% of upper extremity fractures in adults. Simple non-comminuted fractures are traditionally fixed using the tension band wiring technique. This technique, however, has several complications, most commonly prominence of the metalwork frequently requiring surgery for removal. We describe a retrospective review of a new method of fixation for these fractures using partially threaded screws in an attempt to avoid these complications. We used two 3.5 and/or 4 mm partially threaded screws to fix seven simple olecranon fractures and two olecranon osteotomies. Notes and clinic letters of all nine patients were reviewed for demographic data, operation details and complications. Radiographs were reviewed at final clinical follow-up. The Mayo Elbow Performance Score was completed during a telephone consultation. One patient injured her elbow postoperatively, which resulted in fragmentation of the proximal segment and loss of fixation. In one patient the tip of the screws broke after a fall but this did not result in loss of fixation. There were no problems with metalwork prominence or skin irritation in any of the patients. Two patients had low scores due to loss of fixation, and severely comminuted supracondylar fracture of the humerus. Six patients had good scores. We believe that use of AO compression screws is a valid method for the fixation of simple fractures of the olecranon. It is a safe technique and has several advantages over tension band fixation. There is minimal tissue dissection and operating time is decreased. There is minimal risk of metalwork prominence as screws obtain good purchase in the anterior cortex of ulna. Good interfragmentary compression is achieved as screws are perpendicular to the fracture line and two screws provide good rotational stability. Protection of fixation for 1014 days does not result in significant loss of range of motion. Further clinical and biomechanical studies are suggested to compare this technique with other methods of fixation of olecranon fractures.