Olecranon Fractures Research Articles

Common elbow injuries in children

Elbow injuries are one of the commonest paediatric musculoskeletal injuries. Their spectrum varies from pulled elbow to elbow dislocation. Supracondylar fractures are the most common type of paediatric elbow fractures accounting for 65–75 % of all paediatric elbow injuries. Other common paediatric elbow injuries include Lateral condyle fractures, Medial epicondyle fractures, Radial neck fractures, olecranon fractures, TRASH injuries and Elbow dislocations. Osteochondral fractures in kids can be missed due to their benign appearance or invisibility on x rays. TRASH stands for “The Radiological Appearance Seems Harmless”. In contrast to the full form, the abbreviation TRASH tells the harmful consequences of missing these injuries. This article will discuss the salient points regarding common elbow injuries, their diagnosis and best treatment practices. It will help the caregivers to be more prepared to deal with these situations and thus avoiding complications and getting better outcomes.

Radial neck fracture in children-"Abenign fracture?"

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of8 and 12 years old are more frequently affected, whereby acubitus valgus variant can be apredisposing factor. The main trauma mechanism is afall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while asurgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using aelastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires acomprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

Olecranon fractures: An old fixation device for a new surgical technique.

Internal fixation in not-comminuted oblique and transverse olecranon fractures is commonly performed with tension band wiring. However, despite its high healing rate, this technique is associated with a high rate of complications, often requiring the removal of fixation devices in up to 80 % of cases. The aim of our study was to describe a surgical technique using eyelet pins that maintains the effectiveness of the classic tension band wiring while reducing intolerance or displacement of the fixation devices. Fifteen patients with surgically treated Mayo type II A or II B olecranon fractures, meeting the inclusion criteria, were enrolled. Clinical and functional assessments were conducted using MEPS and DASH scores at the 12 month follow-up. Additionally, complications and the duration of the operation were documented. Fifteen patients were enrolled, with eight having type II A and seven having type II B olecranon fractures. The mean patient age was 46.8 years, including ten males and five females. Nine cases involved the right side, while six involved the left. At the 12-month follow-up, the mean MEPS score was 98/100, and the DASH score was 9. Two patients (13.3 %) experienced superficial wound infections, and two (13.3 %) had persistent pain at the triceps tendon insertion site. No cases required removal of fixation devices. The eyelet pin system was found to be a safe and effective method for reducing and fixing olecranon fractures. Based on a limited series, this new technique exhibits the same reliability and reproducibility as tension band wiring but with a lower rate of complications.

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.

Clinical and radiographic outcome of tension band suture fixation for displaced olecranon fractures

BackgroundTension band wire fixation (TBW) is a well-described method for treating displaced olecranon fractures. Further surgery is often needed due to wound breakdown or prominent hardware. An all-suture technique has recently been described as an alternative to TBW but radiographic and clinical outcome are not well established. The aim of this single-center retrospective cohort study was to evaluate outcome after treatment with all-suture technique for simple displaced olecranon fractures.MethodsA retrospective review of olecranon fractures in patients (> 18 years) treated for displaced olecranon fractures with tension band suture fixation (TBSF) between February and August 2019 was performed in our facility. Primary outcome was revision surgery, which was assessed four years after surgery. Clinical and radiographical follow-up was performed at two weeks, six weeks, three months and six months to assess union rate, fracture displacement, range of motion (ROM), Quick-DASH and Oxford Elbow Score.ResultsA total of 24 patients were included. Median age was 64 years [IQR:39–73], 9 patients were male and median ASA score was 2 [IQR:1–2]. 15 fractures were Mayo type 2 A and 9 type 2B with minor comminution. At four-year follow-up, three patients had died. None of the remaining 21 patients had undergone revision surgery. At six months, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR:0-4.5] and 47 [IQR:46–48], respectively. Median elbow extension and flexion deficits were 0° [IQR:0-2.25] and 0° [IQR:0–0], respectively. Radiographic union was achieved in all patients. In two cases radiographic loss of reduction and malunion was observed but both patients were asymptomatic and had no functional deficits. One patient refractured the elbow due to a second trauma and was reoperated.ConclusionsTBSF is a promising technique for Mayo type 2 A and 2B fractures with minor comminution. There were no revision surgeries within the first four years. We found good functional outcomes and a high union rate.

Conservative versus surgical treatment for displaced olecranon fractures in the elderly: a retrospective study and a review of the literature.

Surgery is the gold standard treatment of displaced olecranon fracture, but it presents a high rate of complications, especially in the elderly, including wound breakdown and fixation failure. Conservative treatment of these fractures has recently been proposed with good functional outcomes. The aim of this retrospective study was to compare the functional results and level of satisfaction of displaced olecranon fractures which were managed surgically or conservatively in geriatric patients. The rate of implant removal and reoperation in the surgical group were also calculated. Sixteen and eleven patients aged ≥ 75years (mean 83 and 86.2, respectively) with isolated Mayo IIA or IIB olecranon fracture were surgically and conservatively treated, respectively. All but 1 were females. Due to coronavirus pandemic, they were contacted by phone to validated clinical scores (QuickDASH, PREE and VAS), which were used to assess the outcome. At an average follow-up of 26.5months in the conservative group and 53.1 in the surgical group (range 4-82), the mean Quick DASH was 11.67 and 11.2, respectively, while the mean PREE was 11.36 and 12.67, respectively. There was no significant difference in functional outcomes between the two groups, and all patients were satisfied. Seven complications occurred in the surgical cohort (33.3%), requiring reoperation in 4 cases (19%). Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.

Orthogonal plating for complex olecranon fractures: retrospective case series with patient-reported outcomes.

Treatment for complex olecranon fractures with metaphyseal comminution can be challenging. To improve reduction maneuvers and augment stability, we apply a small medial and/or lateral locking compression plate (LCP) prior to placing a posterior contoured 3.5mm-2.7mm LCP. The aim is to describe our technique and outcomes of this "orthogonal" plating technique. 26 patients were treated with orthogonal plating. Clinical outcome variables were available for all patients at a median of 27 months (IQR 6-54), and patient-reported outcomes (Q-DASH and MEPS) for 23 patients at 38 months (IQR 18-71). All fractures healed at a median of 2.0 months (IQR 1.5-3.8). The median elbow flexion was 120°, extension-deficit 15°, pronation 88°, and supination 85°. The median Q-DASH was 9 (IQR 0-22) and the median MEPS was 90 (IQR 80-100). Hardware was electively removed in seven patients. One patient had a late superficial infection that resolved with hardware removal and antibiotics, and one patient had two consecutive re-fractures after two hardware removals; and healed after the second revision surgery. Orthogonal plating with a posterior LCP and a small medial and/or lateral LCP is a safe technique that leads to excellent healing rates, and good clinical and patient-reported outcomes.

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Functional outcomes and complications of anatomical plate and screw fixation in closed olecranon fractures: A prospective case study

Successful Treatment of Olecranon Fracture with Tie-in External Fixator in a Cat

In this case report, A 4-months-old, male, British shorthair cat was presented with lameness and swelling in the forelimb and loss of appetite after a fall from a height. On the orthopedic examination, pain, lameness, abnormal mobility, local sensitivity, crepitation, and deformation findings were observed in the forelimb. Clinical and radiological examinations revealed an avulsion fracture of the left olecranon. The fracture was treated with an external fixator. Clinical and radiological controls were performed on the 10th, 21st, 30th, and 45th postoperative days. The external fixator was removed on the 62nd postoperative day under sedation. This case report aimed to contribute to the literature on the successful treatment of fracture of the olecranon with an external fixator in a 4-months-old young cat.

Ilizarov technique for treating elbow stiffness caused by myositis ossificans: A case report

BACKGROUND Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment approach, preventing recurrence and standardized rehabilitation are also crucial. Here, we present a surgical strategy to prevent the recurrence of MO. CASE SUMMARY A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon. However, incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification, causing a loss of normal range of motion. The patient was diagnosed with MO based on physical examination, X-ray findings, and clinical presentation. We devised a surgical strategy to remove MO, followed by fixation with an Ilizarov frame, and implemented a scientifically reasonable rehabilitation plan. The surgery lasted for 3 h with an estimated blood loss of 45 mL. A drainage tube was placed after surgery, and fluid was aspirated through ultrasound-guided puncture. The patient experienced a significant reduction in joint stiffness after surgery. In the final follow-up at 9 mouths, there was evident improvement in the range of motion of the elbow joint, and no other symptoms were reported. CONCLUSION The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal. It offers benefits such as passive recovery, individualized treatment, and prompt recovery.

Pediatric Olecranon Fracture with Coronoid Process Osteochondral Flap Fracture: A Rare and Challenging Case

Pediatric Olecranon Fracture with Coronoid Process Osteochondral Flap Fracture: A Rare and Challenging Case

The effect of Ding’s screws and tension band wiring for treatment of olecranon fractures: a biomechanical study

Although tension band wiring (TBW) is popular and recommended by the AO group, the high rate of complications such as skin irritation and migration of the K-wires cannot be ignored. Ding’s screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by biomechanical testing. We conducted a Synbone biomechanical model by using three fixation methods: DSTBW, intramedullary screw and tension band wiring (IM-TBW), and K-wire TBW, were simulated to fix the olecranon fractures. We compared the mechanical stability of DSTBW, IM-TBW, and TBW in the Mayo Type IIA olecranon fracture Synbone model using a single cycle loading to failure protocol or pullout force. During biomechanical testing, the average fracture gap measurements were recorded at varying flexion angles in three different groups: TBW, IM-TBW, and DSTBW. The TBW group exhibited measurements of 0.982 mm, 0.380 mm, 0.613 mm, and 1.285 mm at flexion angles of 0°, 30°, 60°, and 90° respectively. The IM-TBW group displayed average fracture gap measurements of 0.953 mm, 0.366 mm, 0.588 mm, and 1.240 mm at each of the corresponding flexion angles. The DSTBW group showed average fracture gap measurements of 0.933 mm, 0.358 mm, 0.543 mm, and 1.106 mm at the same flexion angles. No specimen failed in each group during the cyclic loading phase. Compared with the IM-TBW and TBW groups, the DSTBW group showed significant differences in 60° and 90° flexion angles. The mean maximum failure load was 1229.1 ± 110.0 N in the DSTBW group, 990.3 ± 40.7 N in the IM-TBW group, and 833.1 ± 68.7 N in the TBW group. There was significant difference between each groups (p < 0.001).The average maximum pullout strength for TBW was measured at 57.6 ± 5.1 N, 480.3 ± 39.5 N for IM-TBW, and 1324.0 ± 43.8 N for DSTBW. The difference between maximum pullout strength of both methods was significant to p < 0.0001. DSTBW fixation provides more stability than IM-TBW and TBW fixation models for olecranon fractures.

Combined ultrasound‐ and nerve stimulator‐guided brachial plexus nerve block in a pig undergoing olecranon fracture repair

AbstractA male pot‐bellied pig was presented for left thoracic limb lameness. A fracture of the olecranon apophysis with displacement was diagnosed, and fracture stabilisation was performed under general anaesthesia. After anaesthetic induction, an axillary brachial plexus nerve block (BPB) with bupivacaine was performed using a portable ultrasound device and a nerve locator. Heart rate and blood pressure were monitored for nociception and the need for analgesic intervention during the procedure. No analgesic intervention was deemed necessary, as the pig did not meet predefined nociceptive thresholds. The pig recovered from general anaesthesia uneventfully without clinical signs of pain or complications. The affected limb was knuckled and lacked conscious proprioception immediately after recovery. Sixteen hours after BPB, knuckling resolved, and normal conscious proprioception was observed. No obvious adverse effects from BPB were noted. The combination of ultrasound and nerve stimulator‐guided BPB with bupivacaine was successful in a pig.

Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures

BackgroundTension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. MethodsThe data of 39 patients with olecranon fractures treated with olecranon sled in the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18–68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. ResultsThirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25–51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°–160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°–180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0–100.0). The mean DASH score was 5.4 ± 4.3 (range, 0–18.3). The mean VAS score was 0.4 ± 0.8 (range, 0–3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. ConclusionOlecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.

Bilateral Olecranon Fracture in a Footballer Following an Overhead Kick

Olecranon fractures are generally caused by indirect trauma following a fall with landing on the hand. On the other hand, bilateral olecranon fractures are rare. Bilateral olecranon fracture is a fairly rare entity. It has been reported in patients with rheumatoid arthritis, osteogenesis imperfecta, stress fracture, and has even revealed sarcoidosis.

Surgical Treatment for Simple Isolated and Displaced Olecranon Fractures: Comparison between Plate and Tension Band Wire Fixation.

Background: Olecranon fractures are common injuries of the upper limb in adults. Simple displaced trasverse fractures are generally surgically treated with tension-band wiring (TBW) or plate fixation (PF). The purpose of this retrospective study is to compare the clinical-functional outcome, complications and reoperation rates between TBW and PF for Mayo IIA fractures. Methods: 72 patients treated with PF or TBW at our institution, completed our survey and clinical evaluation and their demographic and clinical data were recorded and analysed. The clinical-functional outcomes were evaluated assessing ROMs and three validated scoring systems: the Disabilities of the Arm, Shoulder, and Hand (DASH), the Mayo Elbow Performance Score (MEPS) and the Patient American Shoulder and Elbow Surgeons Standardized Elbow Assessment score (pASES-e). Results: 38 patients (53%) underwent TBW and 34 (47%) PF. The mean DASH, MEPS and pASES-e scores were respectively 14.5 ± 17.2, 80.5 ± 14.7 and 83.6 ± 12.4 in the TBW group and 21 ± 21.7, 75.6 ± 15.3 and 75.1 ± 19.2 in the PF group (p = 0.16, p = 0.17 and p = 0.03). The mean duration of surgery and hospitalisation period were longer in the PF group (p = 0.002, p = 0.37) whereas the complication and reoperation rates were higher after TBW (p = 0.15, p = 0.24). Conclusions: According to the literature, both TBW and PF resulted comparable valid surgical options for the treatment of simple isolated displaced olecranon fractures. Our results corroborate previous findings, showing good/excellent outcomes without significant differences.

Triceps Tendon Reattachment Using Mini Plates and Screws After Failure of Olecranon Avulsion Fracture Fixation in Osteoporotic Bone: A Case Report.

This is a case report of an 85-year-old woman with osteopenia who underwent olecranon avulsion fracture repair with supplemental triceps tendon repair following a fall on an outstretched arm. The initial procedure failed due to osteoporotic bone quality and an atraumatic disruption of the olecranon fracture fixation. The patient subsequently underwent further surgical intervention with an olecranon avulsion fracture excision and a novel triceps tendon repair technique using plate augmentation and fiber tape. Surgeons may consider this novel approach as an initial treatment for elderly patients with osteopenia or osteoporosis undergoing olecranon avulsion fracture fixation, to prevent the failure and consequent revision surgery.

Sliding Osteotomy, a New Simple Technique for Olecranon Nonunion Treatment.

Nonunion is a rare complication after surgical treatment of olecranon fracture, but indeed it is a devastating one because of the high potential for elbow stiffness, pain, soft tissue and skin problems, and device complaining. To our knowledge, there is no treatment of choice for olecranon nonunion in the literature. Here we describe a unique and new technique by sliding osteotomy of the olecranon in the form of prism and refixation with tension band wiring. Then, we report the clinical results for our 2 patients operated using this technique.

Mayo classification of olecranon fractures revisited – Assessment of intra- and interobserver reliability based on CT scans

PurposeOlecranon fractures are classified using the commonly accepted Mayo classification. Its reliability has been analyzed by means of radiographs. A CT scan is often obtained due to joint involvement. Purpose of this study was to evaluate the intra- and interobserver reliability of the Mayo classification based on CT examination. MethodsRadiographic and CT images of 20 olecranon fractures were classified by four surgeons at two time points 30 days apart. Intra- and interobserver reliability were assessed using kappa coefficients. ResultsMean intraobserver reliability between X-rays was substantial and between CTs almost perfect (0.76 and 0.82, respectively). Mean interobserver reliability was fair for X-rays and moderate for CTs (0.32 and 0.44, respectively). ConclusionDespite the more detailed imaging compared with radiography only moderate interobserver reliability was found for the classification of olecranon fractures based on CT imaging. This might lead to inconsistent fracture classification in both scientific and clinical setting.

A novel fragment specific classification of complex olecranon fractures: 3-dimensional model design, radiological validation, and proposed surgical algorithm

BackgroundCurrent classifications for proximal ulna fracture patterns rely on qualitative data and cannot inform surgical planning. We propose a new classification system based on a biological and anatomical stress analysis. Our hypothesis is that fragment types in complex fractures can be predicted by the tendon and ligament attachments on the proximal ulna. MethodFirst, we completed a literature review to identify quantitative data on proximal ulna soft tissue attachments. On this basis, we created a 3D model of ulnar anatomy with SliceOMatic and Catia V5R20 software, and determined likely locations for fragments and fracture lines. The second part of the study was a retrospective radiological study. A level-one trauma radiological database was used to identify CT scans of multifragmentary olecranon fractures from 2009 to 2021. These were reviewed and classified according to the “fragment specific” classification and compared to the Mayo and the Schatzker classifications. ResultsTwelve articles (134 elbows) met the inclusion criteria and seven potential fracture fragments were identified. The radiological study included 67 preoperative CT scans (mean 55 years). The fragments identified were: Posterior (40%), intermediate (42%), tricipital (100%), supinator crest (25%), coronoid (18%), sublime tubercle (12%) and anteromedial facet (18%). Eighteen cases (27%) were classified as Schatzker D (comminutive) and 21 (31%) Mayo 2B (stable comminutive). Inter-rater correlation coefficient (ICC) was 0.71 among 3 observers. ConclusionThis proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. Having a more comprehensive understanding of complex proximal ulna fractures would lead to more accurate fracture evaluation and surgical planning.