Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures.

BACKGROUND: In patients managed with plate fixation for the treatment of an olecranon fracture, the placement of an axial intramedullary screw may obstruct the placement of bicortical screws in the ulnar shaft. To overcome this problem, unicortical screws can be applied with use of a contoured locking compression plate. The present study was designed to assess the effectiveness of this fixation method.

METHODS: Nineteen consecutive patients with an acute comminuted olecranon fracture were managed with a contoured locking compression plate and intramedullary screw fixation. Sixteen patients were available for follow-up at a minimum of twelve months after fixation. Patient-based outcomes were assessed, and patient satisfaction and pain were evaluated.

RESULTS: All nineteen fractures healed. The mean time to fracture union was four months. The mean Disabilities of the Arm, Shoulder and Hand score was 13. According to the Mayo Elbow Performance Index and the Broberg and Morrey grading system, fifteen of the sixteen patients with at least one year of follow-up had a good or excellent outcome. Nine patients underwent hardware removal at a mean of twelve months postoperatively. The mean elbow extension deficit in these patients improved significantly from 34 degrees to 10 degrees following hardware removal. The mean flexion improved from 118 degrees to 138 degrees , but this difference was not significant.

CONCLUSIONS: In the treatment of comminuted olecranon fractures, a contoured locking compression plate combined with an intramedullary screw provides sufficient stability for early postoperative functional rehabilitation, with an excellent fracture union rate and very good clinical outcomes.