Abstract
BackgroundIn order to improve initial operative treatment of complex olecranon fractures we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment.Methods80 patients operated with diagnosis of complex olecranon fracture were identified in an 8-year-period from trauma unit files at two European Level 1 Trauma Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified patients with concomitance of an intermediate fragment. The Patient-Rated Elbow Evaluation Score was calculated for 45 of 80 patients at a minimum of 8 months postoperatively (range 8-84 months).Results29 patients were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 patients with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 patients. In 29 of these 52 patients, the intermediate fragment was described in operative report. 24 of these 29 patients were treated with posterior plate osteosynthesis, and 5 patients with figure-of-eight tension band wiring. Complications included superficial infection (2 patients), secondary dislocation (3 patients) and heterotopic ossifications (1 patient). Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 patients.ConclusionAn extraordinary amount of patients showed an intermediate fragment. Consideration, desimpaction and anatomic reduction of the intermediate fragment are necessary preconditions for anatomic restoration of the trochlear notch. There is no clear benefit for plating versus tension band wiring according to our data. In the operative report precise description of the fracture pattern including presence of an intermediate fragment is recommended.
Highlights
In order to improve initial operative treatment of complex olecranon fractures we searched for new determining details
Fracture analysis lacks identification of the intermediate fragment in the diagnostic work up, operative reports do not describe in detail fracture pattern and presence of the intermediate fragment, and insufficient fracture reduction and unstable fixation techniques using figure-of-eight tension band wire fixation were used in many cases resulting in a high rate of revision surgery
An intermediate fragment was seen in 52 patients in conventional radiography and/or computed tomography (CT) scan [Table 2]
Summary
In order to improve initial operative treatment of complex olecranon fractures we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment. 10% of fractures of the adult elbow involve the olecranon process of the proximal ulna and range from simple non-displaced fractures to complex fracture-dislocations of the elbow [1]. Fracture analysis lacks identification of the intermediate fragment in the diagnostic work up, operative reports do not describe in detail fracture pattern and presence of the intermediate fragment, and insufficient fracture reduction and unstable fixation techniques using figure-of-eight tension band wire fixation were used in many cases resulting in a high rate of revision surgery. Hypothesis of this study was that the intermediate fragment plays a key role for anatomic restoration of the trochlear notch contour and consecutive outcome of initial operative treatment of complex olecranon fractures
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