Simple Osteotomy Site Repair Method for the Trans-Olecranon Approach: Tension Band Wiring with Ring Pins

Background: The trans-olecranon approach is commonly used to treat intra-articular distal humeral fractures (DHFs). We describe an osteotomy site repair technique that is both simple and safe. Methods: We retrospectively reviewed 30 patients with intra-articular DHFs who were treated via olecranon osteotomies repaired by tension band wiring (TBW) with ring pins. Medical records and radiographs were retrospectively assessed in terms of injuries, operative characteristics, clinical outcomes, and complications, as well as any need for hardware removal. Clinical outcomes were evaluated by deriving the range-of-motion and the Mayo elbow performance score. Results: Thirty patients (nine men, 21 women; mean age, 49.7 years) with Arbeitsgemeinschaft fur Osteosynthesefragen (AO) type 13-B and 13-C DHFs were included; the mean follow-up time was 49.9 months (range, 12-145 months). Anatomical reduction and bony union were achieved at all osteotomy sites. The mean elbow flexion was 121.7 degrees (range, 100-135 degrees) and the mean elbow extension was 11.3 degrees (range, 0-30 degrees). The mean Mayo elbow performance score was 90 points (range, 55-100 points); outcomes were excellent in 15 patients, good in 12 patients, fair in two patients, and poor in one patient. Olecranon implant removal was performed for 10 patients (33.3%; total removal in nine and isolated olecranon implant removal in one). Four of these patients (13.3%) complained of olecranon implant discomfort. Implants were removed during other surgical procedures from the remaining six patients (20%). No implant migration/breakage or wound complications were encountered. Conclusions: TBW with ring pins is a simple and safe method for olecranon osteotomy site repair.

Automated summary

The trans-olecranon approach for intra-articular distal humeral fractures repaired by tension band wiring with ring pins achieved anatomical reduction and bony union in all osteotomy sites. Clinical outcomes were good in the majority of patients during a mean follow-up of 49.9 months.