Triceps-Sparing Extra-Articular Step-Cut Olecranon Osteotomy
Trans-olecranon chevron osteotomy (CO) is the standard surgical approach to complex intra-articular fractures of the distal humerus. A high complication rate using this technique is described. The extra-articular step osteotomy (SCOOT) is a new technique and a modification of the extra-articular oblique osteotomy (OOT). Using SCOOT as a surgical approach to the elbow increases the bone contact surface area compared to the chevron osteotomy and therefore may improve bone healing. It also may increase the rotational stability of the refixed osteotomy as bony interdigitation at the step may neutralize shear forces from triceps contraction.
The SCOOT uses the same slope as extra-articular oblique osteotomy, and its starting point is the proximal edge of the triceps footprint using a special cutting guide to create the step osteotomy in a standardized fashion. After fixing the fracture, the osteotomy is stabilized by using a tension band wiring technique, or the fixation can be made also using 3.5 mm screws or cerclages around the ulna.
The SCOOT is an interesting alternative for the treatment of complicated intra-articular elbow fractures and gives nearly the same overview of the articular surface and has shown superior biomechanical properties compared to the chevron and extra-articular oblique osteotomy.
KeywordsElbow Trauma Surgical approach Extra-articular osteotomy Olecranon Distal humerus fracture
- 2.Sane AD, Dakoure PW, Dieme CB, Kinkpe CV, Dansokho AV, Ndiaye A, Seye SI. Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases. Chir Main. 2009;28(2):93–8. https://doi.org/10.1016/j.main.2008.12.004.CrossRefPubMedGoogle Scholar
- 9.Zumstein MA, Raniga S, Flueckiger R, Campana L, Moor BK. Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic studies. J Shoulder Elbow Surg. 2017;26:1620–8. https://doi.org/10.1016/j.jse.2017.03.008. pii: S1058-2746(17)30153-2CrossRefPubMedGoogle Scholar