A new technique for olecranon osteotomy in the treatment of distal humeral fractures

Background: Olecranon osteotomy is a commonly used method for obtaining adequate exposure of the articular surface in complex distal humeral fractures. We describe a new technique whereby a precontoured olecranon plate is first fixed to the olecranon, and a Gigli saw is used to perform the osteotomy while the plate is in place. Methods: By use of a standard posterior approach, a precontoured olecranon plate is applied to the olecranon and affixed with screws both proximally and distally to the planned osteotomy site. A Gigli saw is passed anterior to the olecranon and is used to create an osteotomy through the bare area of the sigmoid notch. The plate is removed from the distal fragment. The proximal olecranon fragment, plate, and extensor mechanism are retracted proximally en bloc to expose the articular surface. After fracture repair, the osteotomy fragments are reapproximated, and the plate is reattached to the distal fragment. QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) and Veterans RAND 12-Item Health Survey (VR-12) scores for patients treated with this technique were compared with those of patients treated with the standard chevron osteotomy method. Results: All patients achieved radiographic and clinical union of the osteotomy site. QuickDASH, VR-12 physical, and VR-12 mental scores were not significantly different from those of patients in the chevron osteotomy group (P = .93, P = .79, and P = .68, respectively; t test). Conclusion: The described method provides excellent visualization of the joint, is less technically challenging than the standard chevron osteotomy, and reduces operative time. Osteotomy union was attained in all 5 cases, with functional outcomes comparable with those attained with the chevron technique.