Wedge osteotomy combined with internal fixation in the treatment of Mayo IIB olecranon fractures.

Objective: This study aimed to present the clinical outcomes and establish a safe range for olecranon wedge osteotomy combined with internal fixation in treating Mayo IIB-type olecranon fractures.

Methods: Ten consecutive patients (10 elbows) underwent treatment involving wedge osteotomy combined with internal fixation. Primary outcome measures included the evaluation of the Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), pain severity assessed via a visual analogue scale (VAS), elbow mobility, and the extent of osteotomy at the final follow-up.

Results: At the last follow-up, the median OES was 45 (range 38-48), and the median MEPS was 90 (range 75-100). Six out of 10 patients reported no pain based on the VAS. No significant differences were observed between the healthy and affected sides regarding flexion-extension and rotation activities. The mean horizontal lengths of the olecranon articular surface and base osteotomy were 6.2 mm (range 5.5-7.4 mm) and 14.4 mm (range 10.2-16.5 mm), respectively. The mean olecranon shortening was 4.2 mm (range 2.2-5.4 mm), resulting in a shortening rate of 7.3% to 18.9%. Fracture union was achieved in all patients, with a mean time to union of 11.2 weeks (range 8-16 weeks). Early mild (grade 1) degenerative changes were observed in 3 cases.

Conclusion: Wedge osteotomy combined with internal fixation represents a reliable treatment option for Mayo IIB olecranon fractures, particularly in cases of severe comminuted fractures that are challenging to restore anatomically.

Level of evidence: Level IV, Therapeutic Study.