Clinical Results of Treatment of Comminuted Olecranon Fracture With Free Articular Fragments Using the Embedded Subchondral K-Wire Fixation Along With Plate Fixation.

PURPOSE: Comminuted olecranon fractures with free articular fragments pose considerable surgical challenges because of anatomical complexity and instability of the fracture fragments. This study evaluated the functional and radiological outcomes of embedded subchondral K-wire fixation combined with plate fixation.

METHODS

A retrospective analysis of 14 patients (mean age ± SD: 43 ± 17 years; eight men and six women) treated between 2013 and 2022 was conducted. Inclusion criteria comprised patients diagnosed with comminuted olecranon fractures requiring surgical intervention using embedded subchondral K-wires and plate fixation. Outcomes were assessed using radiographic evaluations (Mayo classification and computed tomography imaging) and functional scores (Mayo Elbow Performance Score and range of motion).

RESULTS

All fractures achieved union by 20 weeks, with 42.9% united by 12 weeks and 85.7% by 15 weeks. Anatomic reduction was achieved in 64.3% of cases, whereas the remaining 35.7% had satisfactory reduction, defined as < 2 mm of articular stepoff with acceptable alignment. The average range of elbow motion at the final follow-up (mean ± SD: 21.3 ± 15.0 months) was 138.2° ± 9.7° flexion, -6.4° ± 6.6° extension, 80.4° ± 15.2° pronation, and 85.4° ± 12.2° supination. The mean Mayo elbow performance score was 95.4 ± 6.9. Complications included hardware irritation (35.7%) and one case each of post-traumatic arthritis and heterotopic ossification. Hardware removal was performed in 71.4% of patients. There were no cases of nonunion or implant failure.

CONCLUSIONS

Embedded subchondral K-wire fixation with plate fixation effectively restores joint alignment and may reduce complications related to extension limitation and post-traumatic arthritis in comminuted olecranon fractures with free articular fragments. However, implant removal was frequently required.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.