L'ostéotomie de l'olécrâne dans le traitement des fractures de la palette humérale de l'adulte : évaluation anatomique et fonctionnelle du coude à propos de 14 cas

Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bicondylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bicondylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.