Role of olecranon osteosynthesis types and approaches in surgical treatment of patients with distal humerus fractures: a systematic review

Introduction Distal humerus fractures account for about 2 % of all fractures, with annual fracture incidence up to 5.7–8.3 cases per 100,000 population. In this regard, optimal surgical treatment methods continue to be sought. Despite the widespread use of olecranon osteotomy to approach the humerus, the choice of an osteotomy type and fixator for an artificial fracture consolidation remains with the surgeon. This paper systematizes the available literature related to types of osteotomies, types of fixators, and characteristics of complications.

Purpose To evaluate the results of performing olecranon osteotomy to approach the humeral trochlea in the treatment of distal humerus fractures, to determine the optimal type of approach, type of osteotomy and type of fixators for an artificial olecranon fracture in the surgical treatment of distal humerus fractures.

Material and methods The search for publications was carried out in the PubMed, Google Scholar, eLibrary databases for the period from 2020 to 2025. Studies that described olecranon osteotomy in the surgical treatment of distal humerus fractures (DHFs) were selected. After evaluating 595 articles, 18 studies with a total sample size of 640 patients were included in the systematic review according to the PRISMA criteria.

Results and discussion The results of the review are: the overall incidence of delayed consolidation was 5 out of 112 cases (4.46 %), pseudarthrosis developed in 24 out of 416 (5.76 %), and metal implant broke in 10 out of 150 (6.6 %). Development of surgical site infection in the early postoperative period was described in 37 out of 473 (7.82 %). Metal implants were removed in the postoperative period in 55 out of 297 cases (18.51 %). The incidence was calculated based on the available data for each described complication.

Conclusion The results of olecranon osteotomy used to approach to the humeral trochlea in distal humerus fracture treatment have been evaluated. Based on the results of this systematic review, it is impossible to indicate the optimal approach, type of osteotomy and type of fixation due to the limited data. However, given the available statistics, it is possible to assume the advantage of the Tension Band Wiring (TBW) method. Therefore, the issue of conducting experimental and prospective studies remains open.

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