Minimally Invasive Screw Fixation of Olecranon Fractures

OBJECTIVES: To evaluate the indications, clinical outcomes, and complications of a minimally invasive technique using intramedullary screw fixation for the treatment of olecranon fractures. METHODS: Design: Retrospective case series. SETTING: Single-center academic hospital. PATIENT SELECTION CRITERIA: Adult patients with closed Mayo type IA, IB, IIA, or IIB olecranon fractures (OTA/AO 2U1B1d[1], 2U1B1e[1], 2U1B1d[2], or 2U1B1e[2]) treated surgically with a minimally invasive intramedullary screw osteosynthesis technique between December 2017 and April 2023 were included. Fractures with high comminution, fracture-dislocations, associated vascular or nerve injury, previous elbow surgery or traumatic injury affecting the ipsilateral elbow, and inadequate follow-up were excluded. OUTCOME MEASURES AND COMPARISONS: Primary outcomes included the Mayo Elbow Performance Score (MEPS), elbow range of motion (ROM), and complications. Major intraoperative complications were defined as neurovascular injuries, intraoperative clinical emergencies, iatrogenic comminution, or unplanned conversion to another fixation technique. No control group was included. RESULTS: A total of 31 patients were included. Mean age was 54.3 years (range 21-87 years), and 19 patients (61.29%) were female. The median follow-up was 35 months (range 12-77 months). The median time from trauma to surgery was 11 days (range 3-17 days). 30 patients achieved good or excellent scores in the MEPS. The median flexion-extension arc of motion was 130° (interquartile range: 120-140°), with 28 of 31 patients achieving 100° or more. No major intraoperative complications or infections occurred. One patient (3.2%) presented loss of reduction and screw migration. Three patients (9.7%) required reintervention, one for early loss of reduction and two for symptomatic hardware removal. CONCLUSIONS: Minimally invasive olecranon osteosynthesis using an intramedullary screw demonstrated good functional outcomes and a low complication rate for undisplaced fractures. LEVEL OF EVIDENCE: IV.