Olecranon Fracture-dislocations Research Articles

Combined posterior and medial plate fixation of complex proximal ulna fractures

Olecranon fracture dislocations often create complex fractures of the proximal ulna including fragmented coronoid fractures. Olecranon fracture dislocations can occur in an anterior or a posterior direction. In an anterior olecranon (transolecranon) fracture dislocation, the radius and ulna both dislocate anteriorly, the forearm relationships remain intact and the coronoid fracture is usually simple. Posterior olecranon fracture dislocations and varus posteromedial rotational injuries can have greater coronoid fragmentation. Coronoid fragmentation can be difficult to repair with a posterior plate and screws alone. The recently recognised fractures of the anteromedial facet of the coronoid are typically secured with a medial plate and screws, usually acting as a buttress plate. Recently, we have begun treating complex proximal ulna fractures – particularly those with fragmentation of the coronoid – with combined posterior and medial plating of the proximal ulna.

Anterior Olecranon Fracture-Dislocations of the Elbow in Children

A subset of olecranon fractures with loss of normal articular apposition (subluxation or dislocation) is recognized in adults as anterior and posterior olecranon fracture-dislocations1-6, but such injuries in skeletally immature patients have been rarely described7-9. The anterior olecranon fracture-dislocation may resemble an anterior Monteggia lesion in that there is anterior dislocation of the radial head with respect to the capitellum; however, the forearm (the radioulnar relationship) remains intact and the injury is primarily to the ulnohumeral joint by means of disruption of the trochlear notch (Figs. 1-A and 1-B). The coronoid is fractured in approximately half of the patients, the radial head is rarely injured, and the collateral ligaments are generally spared10. Olecranon fractures are relatively uncommon in skeletally immature patients11-13, and we were able to identify the cases of only three skeletally immature patients with an apparent anterior olecranon fracture-dislocation reported in the literature7-9. Figs. 1-A and 1-B Drawings differentiating between anterior olecranon fracture-dislocation and anterior Monteggia injuries. Fig. 1-A In the anterior olecranon fracture-dislocation, the proximal radioulnar joint remains aligned and intact, but there is an anterior dislocation of the radiocapitellar joint along with the rest of the forearm. Fig. 1-B In the anterior Monteggia fracture, there is a fracture of the ulna with anterior dislocation of the radial head. We identified four skeletally immature patients with an anterior olecranon fracture-dislocation from a fracture registry. This report describes the injury characteristics, treatment methods, and results of these four patients. ### Materials and Methods Between 1974 and 2002, all fractures treated at our institution were entered into a database …

Long-Term Outcome of Operatively Treated Fracture-Dislocations of the Olecranon

To report the long-term results of operative treatment of anterior and posterior olecranon fracture-dislocations and compare them with the results recorded fewer than 2 years after surgery. Retrospective case series with long-term evaluation. Level I trauma center. Ten patients with anterior olecranon fracture-dislocation and ten patients with posterior olecranon fracture-dislocation were evaluated after an average of 18 years (range, 11 to 28 years) after injury. Fifteen patients had an early follow-up available at an average 14 months (range, 6 to 24 months) after surgery. The average age at injury was 30 years (range, 14 to 53 years). Treatment included plate and screw fixation (11 patients), tension band wiring (8 patients), and radiocapitellar transfixation (1 patient). Six patients had additional elbow surgery before the final evaluation. Flexion arc, arthrosis, Mayo Elbow Performance Index (MEPI), Disability of Arm Shoulder and Hand questionnaire (DASH). The mean arc of elbow flexion was 105 degrees (range, 15 to 140 degrees) at 1 year and 122 degrees (range 10 to 145 degrees; P = 0.01) at final evaluation. Radiographic arthrosis was observed in 14 patients (70%): severe in 3, moderate in 2, and mild in 9 patients. Five patients (25%) had ulnar nerve dysfunction at the final evaluation. The MEPI was excellent in 13 patients, good in 4, fair in 2, and poor in 1. The mean DASH score was 9 points (range, 0 to 53 points). The initial results of operative treatment of fracture-dislocations of the olecranon are durable over time.

Functional outcome following treatment of transolecranon fracture-dislocation of the elbow

Elbow fracture-dislocations are considered as difficult injuries to treat. Anterior olecranon fracture-dislocation consist an uncommon pattern which is likely to be under-diagnosed. Eight patients identified as anterior fracture-dislocation of the elbow were retrospectively reviewed. There were seven men and one woman with an average age of 35 years (range, 22-58 years). Proximal ulna fracture was comminuted in seven and simple oblique in one patient. Associated fractures were of coronoid in four and radial head in two. Reconstruction plate was used in seven patients and tension band wiring in just one. Nevertheless, tension wiring failed and was successfully revised to plate fixation combined with bone graft. Patients were followed for an average of 37.4 months (range, 10-50 months). The end results were two excellent, five good and one fair, based on Broberg and Morrey scale. An average score of 89 points was obtained using American Shoulder and Elbow Surgeons elbow scoring system. Treatment of anterior olecranon fracture dislocation is mostly satisfactory if contour and dimension of greater sigmoid notch is accurately restored.

Coronoid Fracture Patterns

It has been suggested that specific types of coronoid fractures are associated strongly with specific patterns of traumatic elbow instability. This hypothesis was tested in a review of a large consecutive series of patients with a fracture of the coronoid as part of a fracture-dislocation of the elbow. One surgeon repaired 67 coronoid fractures as part of a fracture-dislocation of the elbow over a 7-year period. Each coronoid fracture was characterized on the basis of surgical exposure. Pearson chi-square analysis was used to evaluate the association of the coronoid fracture type with 1 of 4 common patterns of elbow fracture-dislocation. The coronoid fracture was associated with an anterior (6 patients) or posterior (18 patients) olecranon fracture-dislocation in 24 patients, an elbow dislocation and radial head fracture in 32 patients, and a varus posteromedial rotational instability pattern injury in 11 patients. Among the 24 patients with olecranon fracture-dislocations 22 had large coronoid fractures and 2 had small (<50%) coronoid fractures. All 32 patients with terrible-triad injuries had small (<50%) coronoid fractures with 1 of these being a fracture of the anteromedial facet of the coronoid. Among patients with varus posteromedial rotational pattern injuries 9 had small fractures of the anteromedial facet and 2 had larger fractures. The association of coronoid fracture type with injury pattern was strongly statistically significant for both classification systems. The following strong associations were confirmed by this study: large fractures of the coronoid process with anterior and posterior olecranon fracture-dislocations, small transverse fractures with terrible-triad injuries, and anteromedial facet fractures with varus posteromedial rotational instability pattern injuries. An awareness of these associations and their exceptions may help guide the optimal management of these injuries. Therapeutic, Level IV.

Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow

Purpose To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation. Methods Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoid process and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process. Results At an average follow-up period of 57 months stability was restored in every patient. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 and the average Mayo score was 84, with 6 excellent, 4 good, and 3 fair results. The average arc of ulnohumeral motion was 99°. Six patients had radiographic signs of arthrosis including 5 of 6 patients with olecranon fracture-dislocations. Conclusions A stable, functional elbow can be restored in most patients with persistent instability after fracture-dislocation of the elbow using a treatment protocol incorporating hinged external fixation.

Surgical Exposure of Coronoid Fractures

Summary:Recognition of the important role of the coronoid process to the stability of the elbow has contributed to a greater interest in internal fixation of coronoid fractures. Large fractures are usually associated with olecranon fracture-dislocations and smaller fractures with terrible triad inju

Functional Results of Olecranon Fracture-Dislocation According to the Methods of Internal Fixation

Functional Results of Olecranon Fracture-Dislocation According to the Methods of Internal Fixation