• OBJECTIVES
    • To determine if inclusion of an olecranon osteotomy to the posterior paratricipital approach for operative fixation of distal humerus fractures significantly affects surgical complication rates (OTA/AO 13).
  • DESIGN
    • Retrospective comparative cohort study.
  • SETTING
    • Level 1 trauma center.
  • PATIENTS/PARTICIPANTS
    • Three hundred four patients underwent open reduction internal fixation of a distal humerus fracture between 2007 and 2017. Of those, 134 met inclusion criteria (≥15 years, OTA/AO fracture type 13A, B, or C, and posterior surgical approach) for the study (n = 64 with olecranon osteotomy; n = 70 without olecranon osteotomy).
  • INTERVENTION
    • Open reduction internal fixation of distal humerus fractures performed using a posterior paratricipital approach with or without olecranon osteotomy.
  • MAIN OUTCOME MEASURE
    • Ulnar neuropathy (UN), fracture site bony nonunion, and surgical site infection (SSI).
  • RESULTS
    • Thirty-one (33.3%) who underwent the paratricipital approach without olecranon osteotomy, and 15 patients (26.8%) who underwent olecranon osteotomy reported postoperative UN with no significant difference between approaches (P = 0.438). There was no significant difference in rates of SSI (P = 0.418) or fracture site nonunion (P = 0.263) when comparing the approaches. Subjects with Charlson comorbidity index ≥2 were more likely to not undergo an olecranon osteotomy (P = 0.01), whereas subjects with more complex fractures by OTA/AO classification were more likely to have an olecranon osteotomy approach (P = 0.001).
  • CONCLUSIONS
    • Addition of an olecranon osteotomy with the paratricipital approach for fixation of distal humerus fractures does not result in higher rates of UN, fracture site nonunion, or SSI.
  • LEVEL OF EVIDENCE
    • Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.