Abstract
PurposeOlecranon fractures are common and typically require surgical fixation due to displacement generated by the pull of the triceps muscle. The most common techniques for repairing olecranon fractures are tension-band wiring or plate fixation, but these methods are associated with high rates of implant-related soft-tissue irritation. Another treatment option is fixation with an intramedullary screw, but less is known about surgical results using this strategy. Thus, the purpose of this study was to report the clinical and functional outcomes of olecranon fractures treated with an intramedullary cannulated screw.MethodsWe identified 15 patients (average age at index procedure 44 years, range 16–83) with a Mayo type I or IIA olecranon fracture who were treated with an intramedullary cannulated screw at a single level 2 trauma center between 2012 and 2017. The medical record was reviewed to assess radiographic union, postoperative range of motion and complications (including hardware removal). Patient-reported outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Average follow-up was 22 months (range 8–36 months).ResultsBy the 6th month post-operative visit, 14 patients had complete union of their fracture and 1 patient had an asymptomatic non-union that did not require further intervention. Average flexion was 145° (range 135–160) and the average extension lag was 11° (range 0–30). Implants were removed in 5 patients due to soft-tissue irritation. Average DASH score (± standard deviation) by final follow-up was 16 ± 10.ConclusionsFixation of simple olecranon fractures with an intramedullary screw is a safe and easy fixation method in young patients, leading to good functional and radiological results. Compared to available data, less hardware removal is necessary than with tension-band wiring or plate fixation.
Highlights
Olecranon fractures are relatively common injuries and account for approximately 10% of upper extremity fractures in adults [1]
Fragment often leads to disruption of articular congruity and of the elbow’s extension mechanism. This injury is typically treated with open reduction and internal fixation (ORIF) [1,2,3,4,5]
As the skin is thin at the proximal ulna with relatively little subcutaneous tissue, these fixation methods often lead to implant-related soft-tissue irritation necessitating implant removal in 68–82% of the cases largely based on the fixation method that was used [3,4,5, 12]
Summary
Olecranon fractures are relatively common injuries and account for approximately 10% of upper extremity fractures in adults [1]. Traction of the triceps on the proximal fragment often leads to disruption of articular congruity and of the elbow’s extension mechanism. As a result, this injury is typically treated with open reduction and internal fixation (ORIF) [1,2,3,4,5]. Common techniques to treat simple olecranon fractures are tension-band wiring and plate fixation [1,2,3,4,5,6,7,8,9,10,11]. Successful fixation with an intramedullary screw was first described in 1942 by MacAusland, but subsequent reports noted that the technique was challenging and unreliable [11, 15,16,17,18]
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