Sinkler Margaret A, Adelstein Jeremy M, Kodsy Mark M, Ochenjele George, Sontich John K, Wetzel Robert J, Napora Joshua K
University Hospitals Cleveland Medical Center, Cleveland, USA.
Eur J Orthop Surg Traumatol. 2024 Dec 28;35(1):49. doi: 10.1007/s00590-024-04169-1.
Olecranon osteotomy has been associated with loss of reduction, nonunion, implant failure, and migration of wires. We aim to evaluate quality of reduction of the osteotomy site as a predictor of olecranon osteotomy nonunion.
One hundred and twenty-five distal humerus fractures that underwent open reduction internal fixation (ORIF) were reviewed. Amount of dorsal step-off was measured from the lateral radiograph from the second postoperative visit. A receiver operating curve (ROC) analysis was used to assess the predictability of nonunion based on dorsal displacement of the olecranon osteotomy.
Between 2014 and 2022, 36 patients underwent a chevron olecranon osteotomy (29%). Of the 36 patients, 7 (19%) failed to successfully unite at the osteotomy site. Two experienced aseptic nonunion, 2 were malreduced leading to nonunion, 2 malunited, and 1 had persistent fracture lines following poor osteotomy cut. Patients that developed nonunion had a mean dorsal displacement of 3.87 mm versus 1.15 mm (p < 0.001). The ROC demonstrated excellent prediction for nonunion based on displacement (AUC = 0.896, p = 0.002). Youden's index was determined at a sensitivity of 86% and a specificity of 73% corresponding to a dorsal step-off of 2.07 mm. This finding was confirmed on multivariate logistic regression showing a step-off over 2.07 mm is an independent predictor of olecranon osteotomy nonunion (p = 0.021).
A malreduction resulting in a dorsal step-off larger than 2.07 mm is predictive of olecranon osteotomy nonunion or malreduction. Therefore, the success of the olecranon osteotomy approach is directly dependent on quality of anatomic reduction.
III; Retrospective Cohort Study.
鹰嘴截骨术与复位丢失、骨不连、植入物失败及钢丝移位有关。我们旨在评估截骨部位的复位质量，作为鹰嘴截骨术骨不连的预测指标。
回顾了125例接受切开复位内固定（ORIF）的肱骨远端骨折病例。术后第二次随访时，通过外侧X线片测量背侧台阶的大小。采用受试者工作特征曲线（ROC）分析，基于鹰嘴截骨术的背侧移位评估骨不连的预测性。
2014年至2022年间，36例患者接受了V形鹰嘴截骨术（29%）。在这36例患者中，7例（19%）截骨部位未能成功愈合。2例发生无菌性骨不连，2例因复位不良导致骨不连，2例愈合不良，1例截骨切口不佳后骨折线持续存在。发生骨不连的患者平均背侧移位为3.87mm，而未发生骨不连的患者为1.15mm（p<0.001）。ROC显示基于移位对骨不连有良好的预测性（AUC=0.896，p=0.002）。约登指数在灵敏度为86%、特异度为73%时确定，对应背侧台阶为2.07mm。多因素逻辑回归证实了这一发现，显示台阶超过2.07mm是鹰嘴截骨术骨不连的独立预测指标（p=0.021）。
导致背侧台阶大于2.07mm的复位不良可预测鹰嘴截骨术骨不连或复位不良。因此，鹰嘴截骨术的成功直接取决于解剖复位的质量。
III级；回顾性队列研究。
