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Screw, washer fixation effective for securing olecranon osteotomy
Patients who received screw and washer fixation after olecranon osteotomy experienced similar or lower complication rates compared with other fixation methods, according to study results.
Researchers prospectively reviewed 160 patients with distal humerus fractures who underwent olecranon osteotomy and received screw and washer fixation alone, screw and washer with tension band augmentation, tension band wiring alone or plate fixation.
The study’s primary outcome measure was the presence of osteotomy union, and secondary outcome measures were olecranon nonunion, loss of articular reduction and removal of hardware. The researchers used logistic regression to determine the associations between method of osteotomy fixation and removal of hardware or nonunion rates and used Charlson comorbidity index to stratify comorbidities.
Results showed an overall infection rate of 8.8% for all patients, with nine patients presenting with an open injury. Patients with an open injury had a significantly higher postoperative infection rate vs. patients with closed injuries, according to the researchers. Patients who received plate fixation experienced the highest infection rate (18.8%), whereas patients who had screw and washer fixation experienced the lowest infection rate (5.1%). When compared with other tested fixation methods, the researchers found patients who received tension bands alone experienced the highest complication rates in all outcomes measured.
Equal or better rates of union, maintenance of reduction, absence of infection and implant removal were found in the screw fixation group compared with alternative fixation techniques. The tension band group had a 3.68-times-higher estimated odds of implant removal after healing and a 10.06-times-higher estimated odds of having a nonunion vs. the screw and washer group, according to the researchers.
Regardless of fixation method, the researchers found patients who developed a nonunion postoperative complication experienced a statistically higher Carlson score vs. patients who had no complications. – by Casey Tingle
Disclosure: The authors have no relevant financial disclosures.