• David S Wellman, Lionel E Lazaro, Rachel M Cymerman, Thomas W Axelrad, David Leu, David L Helfet, and Dean G Lorich.
• *Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; and †Department of Orthopaedic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY.
• J Orthop Trauma. 2015 Jan 1; 29 (1): 36-43.

ObjectivesTo evaluate the outcomes of olecranon fractures treated with 2.4- and 2.7-mm plate constructs.DesignRetrospective Case Series.SettingOne-level 1 trauma center and 1 tertiary care hospital.PatientsThirty-five consecutive patients meeting inclusion criteria.InterventionA 2.7- or 2.4-mm reconstruction plate was placed on the dorsal ulnar cortex and contoured to allow passage of either a 2.7- or 3.5-mm intramedullary screw. In 9 patients, additional plates were required to control comminution. Available computed tomographic (CT) scans were evaluated for the presence of comminution.Main Outcome MeasurementsAverage Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo Elbow Performance Score (MEPS).ResultsAll fractures were united. Average extension deficit was 4.2 degrees, and average flexion angle was 137.4 degrees. Outcome scores were completed by 94% (33/35) of study patients. Average DASH score was 6.6, and average MEPS score was 94.5. Implants were removed in 18 patients. In the cohort of patients with CT scans, 6 of the 7 fractures thought to be simple on plain film analysis were found to have occult comminution on CT scan.ConclusionsComminution should be considered in all olecranon fractures, even when plain films display simple patterns; although this did not affect treatment in this series of plated patients, it may be important if selecting tension band wiring. Fixation with 2.4- and 2.7-mm plates addresses comminution in olecranon fractures, avoiding the pitfalls of tension band wiring. In patients with completed outcome scores, 97% (32/33) reported their outcomes as good or excellent according to the MEPS.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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