Orthogonal plating for complex olecranon fractures: retrospective case series with patient-reported outcomes

TL;DR

A new surgical technique using orthogonal plating for complex elbow fractures shows good healing and patient outcomes.

Contribution

The novel use of orthogonal plating with a posterior and small medial/lateral plate for complex olecranon fractures is described.

Findings

All fractures healed at a median of 2.0 months with good elbow motion outcomes.

Patient-reported outcomes (Q-DASH and MEPS) showed low disability and high satisfaction.

Hardware removal was safe and effective in managing complications.

Abstract

Treatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5 mm–2.7 mm LCP. The aim is to describe our technique and outcomes of this “orthogonal” plating technique.

26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6–54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18–71).

All fractures healed at a median of 2.0 months (IQR 1.5–3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0–22) and the median MEPS was 90 (IQR 80–100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery.

Orthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.

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