01/07/2010
AO Technical Commission Approved

Olecranon Osteotomy Nail

Comminuted articular distal humerus fractures often require a large access area for anatomical reduction of the joint surface and the metaphyseal area. In these cases an olecranon osteotomy is often performed for better visualization of the fracture area, allowing the tip of the olecranon and the triceps muscle to be moved out of the way. After reconstruction of the distal humerus, the olecranon is usually fixed with two K-wires inserted longitudinally down the ulna combined with a tension band in a figure-of-eight. Alternatively, a 6.5 mm cancellous screw with or without tension band is used. Complication rates after refixation of the olecranon have been described in up to 20% of cases. Typical complications are K-wire migration, prominence of implants requiring secondary operation for removal, loss of fixation especially in osteoporotic bone, increased fracture gaps, and nonunions. In addition, cancellous screws may toggle in the canal causing misalignment at the articular surface, leaving gaps or steps. A high reoperation rate has been reported in the literature. Similar complications have been described in olecranon fractures treated with cerclage wires or cancellous screws.

The olecranon osteotomy nail is indicated to treat simple olecranon fractures and osteotomies of the olecranon. The system enables preosteotomy implant insertion ensuring anatomical alignment and easy fixation of the olecranon osteotomy after distal humerus surgery. The set consists of one single nail, one single end cap, and a range of 2.7 mm screws with a threaded head.

The nail is inserted through a triceps tendon longitudinal split of approximately 1 cm. The entry portal is predrilled and the distal part of the nail is inserted at a position distal to the location of the osteotomy using an insertion handle. The implant is cross locked prior to creating the osteotomy. After the distal humerus is fixed, the osteotomized tip of the olecranon is brought back to its original position and an end cap is inserted through the predrilled hole in line with the nail, reducing the olecranon and creating compression across the osteotomy, ensuring an anatomical reduction/alignment. This procedure allows for a quick and easy realignment and fixation of the olecranon. The locking holes in the distal part of the nail are oblique to each other as well as to the anatomical axis of the ulna. This design prevents the nail from moving within the medullary canal to prevent toggling and ensures anatomical reduction of the olecranon fragment. Targeted locking minimizes the size of the incision. The threaded head of the locking screws sit flush with the surface of the ulna minimizing hardware prominence and soft tissue irritation.

Overall, the olecranon nail system provides more stable fixation with less overall fracture gap motion compared to alternative fixation techniques. Since the implant is inserted prior to the osteotomy, refixation of the olecranon at the end of the procedure is an easy and quick procedure.

A 75-year-old female pedestrian was hit by a car and sustained a 2 open fracture of the distal humerus and an additional pelvic ring fracture.

Case provided by Martin Hessmann, Fulda, Germany

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