Functional and radiological outcomes of plate osteosynthesis for comminuted olecranon fractures: a prospective observational study of 30 patients

Background: Comminuted olecranon fractures disrupt the greater sigmoid notch and are subjected to the deforming pull of the triceps brachii. Tension band wiring does not reliably maintain length or articular alignment when the dorsal cortex is fragmented. This study was performed to determine the functional recovery and radiological union achieved when such fractures are stabilised with plate osteosynthesis, and to define the tempo at which that recovery occurs. Methods: Thirty skeletally mature patients with comminuted olecranon fractures treated by open reduction and internal fixation with dorsal plating at a tertiary care teaching hospital were enrolled in a prospective observational study over 18 months. Gustilo-Anderson type 3C injuries were excluded. All underwent a standardised posterior approach with pre-contoured or reconstruction plating. Function was assessed with the mayo elbow performance score (MEPS) at 6 weeks, 3 months and 6 months; union was assessed on serial radiographs. Results: Mean age was 40.93 (SD 13.06) years and 21 patients (70.0%) were male. Mayo type IIB was the commonest pattern (18, 60.0%). Union was achieved in 30 of 30 patients (100%) at a mean of 10.00 (SD 0.98) weeks. Mean MEPS rose from 54.00 (SD 5.2) at 6 weeks to 77.70 (SD 6.1) at 3 months and 96.20 (SD 8.9) at 6 months, when 24 patients (80.0%) scored a maximum 100. Conclusions: Plate osteosynthesis produced universal union at approximately 10 weeks and excellent 6-month elbow function, with the steepest functional gain occurring between 6 weeks and 3 months.