Low Rates of Conversion to Total Elbow Arthroplasty and Olecranon Osteotomy-Related Complications Following Open Reduction and Internal Fixation for Intraarticular Distal Humerus Fractures

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INTRODUCTION: The purpose of this study was to determine the rate of conversion to total elbow arthroplasty (TEA) following open reduction and internal fixation (ORIF) with olecranon osteotomy for intraarticular distal humerus fractures. METHODS: This retrospective case series included adult patients who underwent ORIF with olecranon osteotomy for AO/OTA 13C distal humerus fractures between January 2010 and April 2024 at two academic level 1 trauma centers. The primary outcome was the rate of conversion to TEA. Secondary outcomes included indications for conversion, TEA complications associated with the osteotomy, osteotomy revision surgery rates (for nonunion, fixation failure, symptomatic implant, and infection), and the rate of osteotomy union. RESULTS: A total of 148 patients were included, with a median age of 58 years (interquartile ranges: 42 to 69) and 78 (53%) were female. Three patients (2.0%) required conversion to TEA at 2, 4, and 21 months post-ORIF because of fixation failure, distal humerus nonunion, and posttraumatic osteoarthritis, respectively. Among geriatric patients, two of 51 (3.9%) required conversion to TEA. One conversion involved complications with ulnar component insertion because of the osteotomy. Regarding osteotomy revision surgeries, four patients (2.7%) underwent revision surgery for nonunion, three (2.0%) for fixation failure, 14 (9.5%) for symptomatic implant, and eight (5.4%) for infection. Osteotomy union was achieved in 145 patients (98%). CONCLUSIONS: Approximately one in 50 patients required conversion to TEA, with only one case involving a TEA complication associated with the prior olecranon osteotomy. When stratified by age, approximately one in 100 patients younger than 65 years and one in 25 geriatric patients required conversion. Revision surgery rates for osteotomy nonunion and fixation failure were similarly low, with 98% of osteotomies achieving union. These findings suggest that ORIF with olecranon osteotomy can be performed for 13C distal humerus fractures with minimal concern for subsequent TEA, osteotomy revision surgery, or nonunion. LEVEL OF EVIDENCE: Therapeutic level IV.

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