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Healing rate of transverse osteotomies of the olecranon used in reconstruction of distal humerus fractures.

To determine the rate of healing of the osteotomy, we studied the cases of 10 patients who had transverse osteotomy of the olecranon for surgical exposure of a complex distal humerus fracture. The average age of the patients was 48 years, and the average follow-up was 24 months. Nine of the fractures were complex supracondylar/intercondylar fractures. All of the humerus fractures were treated with bone plates and screws, and nine of the osteotomies of the ulna were reconstructed with a large lag screw and tension band wire. Smooth pins and a tension band wire were used in 1 patient with osteoporotic bone. Union of the ulnar osteotomy occurred in 7 patients, and 3 of the patients had a nonunion. The average time of healing of the distal humerus fractures was 3.5 months, and the average time of healing of the ulnar osteotomies was 5.2 months. Six of the patients developed a gap at the osteotomy site by displacement or resorption of it, and two of these progressed to a nonunion. The patients whose ulnar osteotomy healed had an average extension lag of 33 degrees, and the average flexion at their elbows was 122 degrees. The patients who had a fibrous nonunion of the ulnar osteotomy had an average extension lag of 27 degrees at the elbow, and all 3 patients had full flexion of the elbow joint. Because of the nonunion rate of 30% in our patients, we no longer use a transverse osteotomy of the olecranon to expose distal humerus fractures at surgery.