Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Chul-Hyun Cho,Sang Soo Na,Beom-Soo Kim,Du-Han Kim,Byung-Chan Choi

doi:10.3390/diagnostics10121058

Chul-Hyun Cho, Sang Soo Na + Show 3 more

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https://doi.org/10.3390/diagnostics10121058

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Journal: Diagnostics	Publication Date: Dec 6, 2020
Citations: 9	License type: CC BY 4.0

Affiliation: Keimyung University

Abstract

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion–extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

Highlights

The elbow is a complex joint consisting of ulnohumeral, proximal radioulnar, and radiocapitellar articulation
Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to intra-articular fracture of the olecranon with no disruption of the proximal radioulnar joint [1,2]
Due to challenges with misclassification and the rare occurrence of trans-olecranon fracture dislocations, they were only recently reported by Biga and Thomine when they were distinguished from Monteggia Bado type 1 fractures [7]

Summary

Introduction

The elbow is a complex joint consisting of ulnohumeral, proximal radioulnar, and radiocapitellar articulation. In the case of trans-olecranon fracture dislocations, damage is the result of high energy in the mid-range flexion state, causing ulnohumeral joint discontinuity and radiocapitellar dislocation, resulting in radial head anterior displacement relative to the capitellum [3]. Trans-olecranon fracture dislocations often accompany radial head fractures or coronoid process fractures [2,4,5,6]. Due to challenges with misclassification and the rare occurrence of trans-olecranon fracture dislocations, they were only recently reported by Biga and Thomine when they were distinguished from Monteggia Bado type 1 fractures [7]. Unlike the Monteggia fracture, the trans-olecranon fracture dislocation preserves the proximal radioulnar joint [8,9], and rarely have an accompanying ligament injury, though joint injury is more extensive than in the Monteggia fracture [10]

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