Comminuted Olecranon Fractures Research Articles

Omega Plate Fixation of Comminuted Olecranon Fractures: Technique and Case Series.

Fixation of olecranon fractures, especially those with minimal proximal bone and those that present with significant comminution, can be technically challenging. Current open reduction and internal fixation (ORIF) methods, such as tension band wire (TBW) constructs, plate fixation (PF), and intramedullary screws (IMSF), have demonstrated high rates of reoperation and symptomatic implants. We present the omega plate technique, which utilizes a mini-fragment plate passed under the triceps tendon insertion, allowing maximal implant surface area contact with small, proximal olecranon fracture fragments. The mini-fragment plate is not placed on the dorsal subcutaneous border of the ulna, which allows it to capture medial and lateral fragments of cortical comminution and may contribute to less soft tissue irritation.

Triple suture fixation for displaced comminuted olecranon fracture with a stable ulnohumeral joint.

To report the outcome of a novel fixation technique using three high-strength sutures which is including articular buttress suture, cerclage suture, and tension band with off-loading triceps suture (triple suture fixation) in the treatment of displaced comminuted olecranon fracture with a stable ulnohumeral joint (Mayo type IIB). The rationale of using this technique is that the sutures have been used to stabilize multiple fracture fragments in all sides of the olecranon. Between July 2018 and July 2021, 10 patients (7 women, 3 men; mean age, 49.9years; mean follow-up duration, 27.8months) with Mayo type IIB olecranon fractures who underwent triple suture fixation were included in the study. The elbow was immobilized in a splint for 2weeks postoperatively. Range-of-motion exercises were initiated after splint removal and weight bearing was allowed at 6weeks postoperatively. Average active range of motion of the elbow was 145° of flexion (range, 135°-150°), 6.5° of extension (range, 0°-30°), 83° of supination (range, 70°-85°), and 77.5° of pronation (range, 70°-80°). Mean MEPS was 98.3 (range, 85-100) and DASH score was 3.1 (range, 0-10) at the final follow-up. Radiographic data at the final follow-up analyzed by paired t test demonstrated that there was no statistically significant difference of proximal olecranon height (OH), trochlear notch width (TW), and OH/TW ratio between postoperative treatment and normal side (p-value >.05). No complication of implant prominence, fixation failure, nonunion, infection or heterotopic ossification was found postoperatively. Breakage of drill bit occurred during drilling a distal oblique hole for articular buttress suture in one patient. The triple suture fixation is an effective treatment with low incidence of complications in treatment of Mayo type IIB olecranon fractures. Larger comparative studies are needed to confirm the value of such technique.

The Evolution of Olecranon Fractures and Its Fixation Strategies.

Olecranon fractures are a common fracture of the upper extremity. The primary aim was to investigate the evolution of olecranon fractures and fixation method over a period of 12years. The secondary aim was to compare complication rates of Tension Band Wiring (TBW) and Plate Fixation (PF). Retrospective Study for all patients with surgically treated olecranon fractures from 1 January 2005 to 31 December 2016 from a tertiary trauma center. Records review for demographic, injury characteristics, radiographic classification and configuration, implant choices and complications. Results grouped into three 4-year intervals, analyzed comparatively to establish significant trends over 12years. 262 patients were identified. Demographically, increasing mean age (48.7 to 58.9years old, p value 0.004) and higher ASA scores (7.1% ASA 3 to 21.0% ASA 3 p value 0.001). Later fractures were more oblique (fracture angle 86.1-100.0 degrees, p value 0.001) and comminuted (Schatzker D type 10.4-30.0%, p value 0.025, single fracture line 94.0-66.0%, p value 0.001). Implant choice, sharp increase in PF compared to TBW (PF 16.0% to PF 80.2%, p value 0.001). Complication-wise, TBW had higher rates of symptomatic implant, implant and bony failures and implant removal. Demographic and fracture characteristic trends suggest that olecranon fractures are exhibiting fragility fracture characteristics (older age, higher ASA scores, more unstable, oblique and comminuted olecranon fractures). Having a high index of suspicion would alert surgeons to consider use of advanced imaging, utilize appropriate fixation techniques and manage the underlying osteoporosis for secondary fracture prevention. Despite this, trends suggest a potential overutilization of PF particularly for stable fracture patterns and the necessary precaution should be exercised.

Mini fragment plating provides a middle ground between tension band wiring and conventional olecranon plating in the management of comminuted olecranon fractures: A case series

BackgroundThe management of comminuted olecranon fractures has plenty of room for improvement. There remains controversy for the ideal treatment modality, with tension band wiring (TBW) and locked plate fixation (LPF) being the most commonly utilised options. However, TBW and LPF have their own benefits and drawbacks. We explore a novel treatment strategy for comminuted olecranon fractures, utilising TBW in conjunction with mini-fragment plate (MFP) fixation. Case detailsWe treated five cases of Mayo Type IIB olecranon fractures with this method. All five patients were found to have union of the fracture. All patients were found to have good or excellent functional outcome. Only one patient complained of hardware prominence. None of the patients were found to have infection, wound complications, nor underwent revision surgery. The radiological outcome in terms of fracture union time and functional outcome in terms of Mayo Elbow Performance Index and Quick Disabilities of Arm Shoulder and Hand Score were comparable to reported outcomes of LPF in similar cases. ConclusionWe therefore propose the use of mini-fragment plates in conjunction with TBW to combine the advantages of TBW and plating, while limiting the drawbacks of traditional locked plate fixation.

Functional outcomes of plate fixation in comminuted fractures of olecranon: A case series

Objectives: To report and evaluate the functional outcome of plate fixation in comminuted olecranon fractures (Mayo types IIB and IIIB).Method: 16 patients with comminuted fractures of the olecranon presented to our unit, were operated on with a locking Olecranon plate. Main outcome measurements included radiographic healing, postoperative range of motion, complications, outcome score and patient satisfaction measured at 1 year follow up. Results: Our study included six females and ten males with a mean age of 48(18–67). Nine were Mayo type IIB and seven were Mayo type IIIB. Fourteen patients had no complications post-operatively with good outcomes with a mean oxford score of 44, full rotational ROM and mean flexion arc of 20-130 deg. Two patients had a range of motion between 40-90 deg with full rotational ROM and a mean oxford score of 28. No patients required hardware removal. No non-unions were noted in our series. Conclusion: Plate fixation of complex olecranon fracture is an effective, reliable treatment method with a low risk of non-union. Restoration of a functional flexion arc of movement can be expected with the use of correct technique and early post-op mobilization.

EVALUATION OF FUNCTIONAL OUTCOME OF MODIFIED TENSION BAND WIRING AT 6 MONTHS IN ISOLATED OLECRANON FRACTURES IN ADULTS

Introduction: Fractures of the olecranon account for 8 - 10 % of all fractures around the elbow joint . An uncomplicated fracture of the olecranon is considered to be a common injury. Incidence in adult population is approximately 11.5% per 1 64 100000 population .Younger individuals suffer fracture olecranon due to high energy trauma and older individuals due to simple fall . When displaced, open reduction and internal xation is usually required to obtain anatomical realignment of the articular surface and restore normal elbow function. The xation should be stable, allow active elbow exion and extension and promote union of the fracture. There are other modalities of xation of isolated olecranon fractures, such as olecranon hook plate and cannulated lag screws as well but tension band wiring is less costly and operative complications are less in non comminuted olecranon fractures. Material and methods: This prospective observational study was done over a period of 2 years on transverse and oblique fractures of olecranon. Results: the outcome of our study was favorable in support of tension band wiring in transverse and oblique fracture of olecranon in respect to union rate, early initiation of physiotherapy and nal range of motion. Conclusion: By this method post-operative immobilization in POP is greatly minimized. Thereby avoiding fracture disease.Because of rigid xation between the fracture fragments, early active and functional movements can be given to the patient reducing the chances of joint stiffness. Early initiation of physiotherapy program within 2 – 3 weeks induces compression between the fragments. This compression hastens fracture healing. Because of early union of fracture, patient is back to work earlier

Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model

Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes. A biomechanical comparison of DLP and PLP fixation would help to validate the use of DLPs in comminuted olecranon fractures. Seven matched pairs of cadaveric upper extremities were evaluated with quantitative computed tomography scans to evaluate bone mineral density (BMD). Osteotomies simulating comminuted olecranon fractures (Mayo Type IIB) were created and the specimens were fixed either with variable angle PLPs or variable angle DLPs. The specimens were then cyclically loaded and loaded to failure. The ultimate strength, fracture displacement, and mechanism of failure were recorded and compared across groups. The correlation between BMD and ultimate strength was analyzed. The mean total BMD was 0.79 g/cm2 (SD, 0.14 g/cm2). No specimen failed during cyclic testing. Five of 7 PLP specimens and 5 of 7 DLP specimens failed by fracture through the proximal screws though in different planes (sagittal vs axial splits, respectively). The mean ultimate strengths of the PLP (1077 N [SD, 462 N]) and DLP (1241 N [SD, 506 N]) groups were similar. There was a linear relationship between ultimate strength and BMD (R2= 0.33). Dual locking plates display biomechanical properties that suggest that they can be used in the fixation of comminuted olecranon fractures. Catastrophic failure of the fixation constructs occurs around stress risers at the proximal screws rather than due to displacement at the fracture itself. Dual locking plate constructs can be considered for use in the fixation of comminuted olecranon fractures.

Pull-out suture repair with Fiber Wire ® for comminuted olecranon fracture after plate fixation

Pull-out suture repair with Fiber Wire <SUP>&reg;</SUP> for comminuted olecranon fracture after plate fixation

The effect of post-fixation olecranon lengthening on range of motion of the elbow: a cadaveric study

BackgroundPrinciples of fixation of comminuted olecranon fractures include anatomical reduction of the articular surface and restoration of ulnohumeral joint motion. However, comminution sometimes may not permit anatomical fixation of fracture fragments, resulting in inadvertent olecranon lengthening after plate fixation. The aim of our study is to investigate the relationship between olecranon lengthening following plate fixation and loss of elbow extension.Materials and methodsTransverse olecranon osteotomies were performed on 8 cadaveric elbows. The osteotomy sites were then fixed with olecranon plates. Lengthening of the osteotomy sites were simulated by placement of 2mm, 4mm, 6mm and 8mm blocks. Lateral view photographs of the elbows were taken after each degree of lengthening. These photographs were then printed and measurements of elbow extension were performed with a goniometer with average values taken. The measurements were tabulated and statistical analysis performed to determine the relationship between degree of elbow extension loss and amount of olecranon lengthening.ResultsAverage values of each degree of lengthening (at 2mm, 4mm, 6mm and 8mm) were taken and compared with the baseline measurement (at 0mm). Cluster analysis showed that for every increment in osteotomy length of 2mm, there is a corresponding increase of 0.79° of elbow extension loss (p<0.01, 95% confidence level 0.55°-1.03°).ConclusionLengthening of olecranon by increments of 2mm correlates positively with loss of elbow extension. This shows that inadvertent intra-operative olecranon lengthening post-fixation may result in limited range of motion. However, it is reassuring to know that the small degree of extension loss may not translate to functional limitation.

Outcomes of embedded rafting k-wire technique for intermediate articular fragment fixation in comminuted olecranon fractures.

Severely comminuted olecranon fractures are challenging injuries. Commonly used tension band wiring exerts excessive compressive forces causing olecranon shortening and joint incongruity. This study aimed to introduce the embedded rafting k-wire technique with the bridging technique for intermediate articular fragment fixation in comminuted olecranon fractures and evaluate its clinical and radiological outcomes. A total of 34 patients with comminuted olecranon fractures were treated with rafting k-wire fixation combined with a locking plate. Time to union, the number of rafting k-wires in the intermediate articular fragment, quality of joint reduction, and secondary reduction loss were analyzed. Elbow range of motion, Mayo Elbow Performance Score (MEPS), and complications were evaluated at the final follow-up. Fracture union was obtained in all patients. The mean number of intermediate articular fragments was 2.4 ± 0.7, and the average number of rafting k-wires was 3.0 ± 1.2. There were mild and moderate degree early posttraumatic osteoarthritis in 6 cases (17.6%) at the mean 20.8months of follow-up. At the final follow-up, the mean range of elbow motion was 4.6° of flexion contracture and 133.5° of further flexion. The average MEPS was 97.1 (range, 75-100). Two patients had heterotrophic ossification without functional impairment. The embedded rafting k-wire technique with bridging plates in comminuted olecranon fractures exhibited satisfactory outcomes. This method might serve as an alternative when considering the ability to restore articular congruency and stability in severely comminuted olecranon fragments. Level IV, therapeutic.

Comminuted olecranon fractures: locking compression plate fixation verses conventional plate fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A variable consensus exists on the optimal management strategies for olecranon fractures. Though the mechanical properties of the conventional plates and the locking plates used show no difference, pre-contoured locking plates provide a significant advantage over non-locking plates in unstable fractures. The aim of the study was to compare clinical and radiological outcomes in the management of the comminute olecranon fractures by anatomically pre-contoured locking compression plates and the conventional plates.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was a prospective study of 50 patients with comminuted olecranon fracture, with 25 patients each randomized into two groups, those that underwent fixation of the fracture using a pre-contoured locking compression plate (group LCP) and those fixed using a conventional plate (3.5 mm reconstruction plate) (group CP). Patients were followed up to 1 year with functional outcome assessed at each follow-up with Mayo elbow performance score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean MEPS (LCP vs CP) at 1.5 (47 vs. 43.4) and 3 (67.4 vs 61.6) months follow up showed a statistically significant difference between the two groups, but the difference was not significant at 6 (86.4 vs 85.6) and 12 (88.4 vs 87) months. The time to union (4.3 months vs 5.0 months) was not significantly different between the groups. There were 11 complications in group LCP and 12 complications in group CP.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In the present study, we suggest that the use of a pre-contoured locking compression plate provides better outcomes at earlier periods as compared to the conventional plate; thus, returning the patient to normal function at the earliest.&lt;/p&gt;

Surgical Treatment of Comminuted Olecranon Fracture Using Locking Compression Plate Fixation

Purpose: Several types of surgical methods from tension band wiring to plate fixation are used in olecranon fractures. In comminuted olecranon fractures, plate fixation is recommended as it is difficult to obtain stable fixation of the bone fragments and joint congruency. The authors performed operations using compression locking plate for olecranon fractures corresponding to Mayo classification IIB and IIIB, and report the radiologic and functional results.Methods: Twenty-one patients who underwent plate fixation surgery for comminuted olecranon fractures at our hospital from September 2011 to April 2019 were enrolled in this study. Patients were retrospectively analyzed for at least 1 year. The classification of olecranon fracture was performed using the Mayo classification. For the analysis of the postoperative results, radiological union time, postoperative range of motion, complications, and functional results based on Mayo elbow performance score (MEPS) were evaluated.Results: The union was achieved in all cases and three posttraumatic arthritis were observed at the final follow-up. The average range of motion was 134.3° in flexion, –9.8° in extension. The mean MEPS was 93.1. There was no statistically significant difference in MEPS between the group that used technique of interfragmentary fixation and the group that did not (p=0.534).Conclusion: Surgical treatment using a locking compression plate fixation in comminuted olecranon fracture resulted in excellent functional results. Restoration of articular surface using Kirschner wire or interfragmentary screw between small bone fragments is considered a useful method for obtaining good functional results.

Tension Band Wiring Provides Excellent Patient-Reported Long-Term Results for Both Comminuted and Simple Displaced Olecranon Fractures.

To assess the long-term functional results of both simple and comminuted olecranon fractures treated with tension band wiring (TBW). Retrospective. Level 1 trauma center. Between 2004 and 2014, 178 fractures in 178 patients >16 years of age were treated with TBW for a unilateral olecranon fracture. Subjective functionality was tested with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Fifty percent of our cohort were lost to follow-up leaving 89 for review. A total of 51.7% had a comminuted fracture. Mean follow-up time was 7.1 years. Reoperation rate for implant removal was 84%. The total median DASH score was 0.83. Eighty-five patients (95.5%) were rated excellent using the MEPI score. No significant difference in either score was found between the simple (SF) and the comminuted (CF) group. Median range of motion was flexion/extension: 145/-2 degrees, supination/pronation: 90/90 degrees. No clinically relevant difference in range of motion was found between the 2 groups. We found no relevant differences in either subjective or objective functionality between patients with simple or comminuted olecranon fractures after fixation with TBW. Therefore, TBW seems to be an adequate and justifiable treatment modality for both simple and comminuted olecranon fractures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The outcome of plate fixation for displaced olecranon fractures

Objectives: To evaluate the outcome of plate fixation for displaced olecranon fracturesMaterials and Methods: the present retrospective study was conducted in the Department of Orthopedics. Total 25 patients who underwent plate fixation of displaced olecranon fractures were reviewed by two surgeons were independently.Results: mean arc of elbow motion 106.20 with range of motion from 10.20-116.70 and excellent clinical outcome was reported among 76% cases as per Broberg and Morrey scale. 22 patients achieved fracture union during 6 months follow up period.Conclusion: locking plate fixation is a safe and effective option for the treatment of comminuted olecranon fractures.

Clinical observation of olecranon sled for the treatment for olecranal fracture

To explore clinical effect of olecranon sled in treating olecranal fracture. Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function. Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0. Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.

Biomechanical study of olecranon plate fixation in comminuted osteoporotic fracture model: locking compression plates versus dynamic compression plates

This cadaveric biomechanical study compared locking compression plates (LCP) to dynamic compression plates (DCP) in a comminuted olecranon fracture using cyclic loading to measure fragment displacement and maximal failure load. Eight paired human cadavers were used. We confirmed all specimens were osteopenic using DEXA. One paired half of the specimens randomly received LCP fixation and the other DCP. Implants were secured to the intact ulna prior to creating an osteotomy. Two vertical osteotomies were created to simulate a fracture gap of 5 mm. The specimens were loaded and placed on the MTS machine. Saw-toothed cyclic loading was applied and force/gap displacement measured. Failure was defined as fracture gap greater than 2 mm or catastrophic failure of the bone/construct. Biomechanical parameters were compared between two groups. The average force for the DCP was 22.12 N compared to 33.40 N (P&lt;0.05) for the LCP. The average gap for the DCP was 7.32 mm compared to 6.40 mm (P&lt;0.05) for the LCP. The force measure was statistically significant at 60, 70, 80, 90, and 100 mm of displacement (P&lt;0.05) for the LCP. This implies that the LCP was able to withstand higher force than the DCP. The gap displacement was statistically significant at 60, 70, 80, 90, and 100 mm of displacement (P&lt;0.05). This implies that the LCP maintained the reduction better than the DCP. No differences in force/gap were noted when comparing gender, right versus left forearm, or osteoporotic versus osteopenic bone. There was no difference when failure occurred between the DCP and LCP groups. Our study found that LCP was able to withstand higher force than DCP, and there was less displacement of the fracture with biomechanical testing in the LCP compared to the DCP. Both could be appropriate surgical techniques for fixation of comminuted olecranon fractures. When treating comminuted and osteopenic fractures, LCP are advantageous. Further studies would be needed to compare these two plates clinically.

Evaluating the Utility of the Lateral Elbow Radiograph in Central Articular Olecranon Reduction: An Anatomic and Radiographic Study.

The surgical reduction of intra-articular olecranon fractures is judged primarily on the lateral elbow radiograph, as orthogonal imaging of the articular surface is not obtainable. We sought to determine surgeon accuracy in identifying intra-articular olecranon malreductions on the lateral elbow radiograph. Six human fresh-frozen cadaveric elbow specimens were sagittally sectioned in 5-mm increments after olecranon dissection, preservation of soft tissue envelope, and rigid fixation of the elbow in an external fixator. Three patterns of central intra-articular olecranon malreduction were created in each elbow using a ruler and bone saw. Perfect lateral elbow radiographs were taken of each malreduction, and these images were randomized along with x-rays of normal cadaveric olecranons. The image series was presented to 4 masked trauma-trained surgeons to determine whether the olecranon was malreduced or anatomic. Surgeons interpreted the same image series on 2 separate occasions separated by 6 weeks. Percent correct was recorded, and the interobserver and intraobserver reliability was calculated. Orthopedic trauma surgeons correctly identified olecranon malreductions only 73% of the time on the lateral elbow radiograph. Interobserver agreement was moderate for the first review of images and fair for the second review, with respective Fleiss Kappa values of 0.43 and 0.28. Intrarater reliability revealed moderate agreement with Cohen's Kappa value ranging from 0.56 to 0.66. Intra-articular olecranon malreductions are inconsistently recognized by trauma surgeons on the lateral elbow radiograph. Therefore, articular incongruity may still be present after surgical fixation of comminuted olecranon fractures. We must further define the radiographic anatomic representation of the articular olecranon to improve surgical reduction and clinical outcomes.

肘頭粉砕骨折に対するdouble plate ostyeosynthesis法

肘頭粉砕骨折に対するdouble plate ostyeosynthesis法

Comminuted olecranon fractures: biomechanical testing of locked versus minifragment non-locked plate fixation.

Open reduction and internal fixation has long been accepted as optimal treatment for displaced olecranon fractures based on poor results seen with conservative management. With the presence of comminution, tension-band wiring constructs are contraindicated due to tendency to compress through fragments, thereby shortening the articular segment. Therefore, plate fixation is typically employed. Our hypothesis was that in a comminuted fracture model, 2.7mm reconstruction plating without locking screws will perform equally to 3.5mm locked plating in terms of fracture displacement and rotation (shear). A three-part comminuted olecranon fracture pattern was created in nine matched pairs of cadaveric specimen using an oscillating saw in standardized, reproducible fashion. Each matched pair was then randomized to receive either 2.7mm reconstruction plating or 3.5mm proximal ulna locked plating. Random allocation software was used to assign the 2.7mm plate construct to either the right or left side of each pair with the contralateral receiving the 3.5mm plate construct. Specimens were cyclically loaded simulating passive range of motion exercises commonly performed during rehabilitation. Displacement and rotation in relation to the long axis of the ulna were measured through motion capture. Fragment gapping and rotation was quantified following 100 cycles at 10N and again following 100 cycles at 500N. No significant differences were detected between the 2.7 and 3.5mm plates in fracture rotation or gapping following loads at 10N (0.5° and 0.7°; 0.6 and 1.2mm; respectively; p>0.05) or 500N (2.3° and 1.6°; 3.8 and 3.1mm; respectively; p>0.05) loading. Fragment rotation and gapping were positively correlated within each plate construct (R 2>0.445; p<0.05). 2.7mm plating is an alternative to 3.5mm locked plating with decreased plate prominence without significantly sacrificing displacement and rotational control. This is beneficial in fracture patterns where the traditional dorsal plating does not offer optimal screw trajectory.

Mini-locking-plate combined with tension band wiring for treatment of comminuted olecranon fracture

Objective To investigate the clinical effect of the mini-locking-plate combined with tension band wiring for fixation of comminuted olecranon fracture. Methods A retrospective review was made on 37 patients with comminuted olecranon fracture fixed using the mini-locking-plate combined with tension band wiring from March 2010 to June 2014. There were 24 males and 13 females, at mean age of 41 years (range, 22-68 years). Fall injury occurred in 22 patients, high fall injury in 8 patients, traffic injury in 4 patients, stick injury in 2 patients and cutting injury in 1 patient. The fracture occurred on the left side in 16 patients and on the right side in 21 patients. Two patients had an open fracture. None suffered from neurovascular injury or elbow joint instability. The duration from injury to operation was 4 to 98 h (mean, 43 h). The elbow function was evaluated according to the Mayo elbow performance score (MEPS). Results Thirty-five patients were followed up for 6 to 26 months (mean, 15 months). Good fracture reduction and flat articular surface were shown on the X-rays. Fracture union was observed in all patients. At the final follow-up, the MEPS ranged from 70 to 100 points (mean, 94 points). Thirty-one patients were rated excellent, 2 good and 2 fair, with the excellent-good rate of 94%. No incision infection or internal fixation failure occurred. Conclusion The procedure is a safe and effective method that allows early functional exercise. Key words: Ulna fractures; Fracture fixation, internal; Tension band wiring