Orthogonal plating for complex olecranon fractures: retrospective case series with patient-reported outcomes

Introduction: Treatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5 mm–2.7 mm LCP. The aim is to describe our technique and outcomes of this “orthogonal” plating technique. Material and Methods: 26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6–54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18–71). Results: All fractures healed at a median of 2.0 months (IQR 1.5–3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0–22) and the median MEPS was 90 (IQR 80–100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery. Conclusion: Orthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.