Treatment Of Olecranon Fractures Research Articles

Surgical treatment of olecranon fractures in children

Background Fractures of the olecranon are relatively uncommon in children and most are non-displaced or minimally displaced. Wire and suture methods have been used to stabilize displaced pediatric olecranon fractures. This study compares differences in the clinical outcome of 15 children either treated with open reduction and screws, tension band suture (TBS), tension band wires (TBW), or plating.

BIOMECHANICAL ASSESSMENT OF TENSION-BAND WIRING FOR OLECRANON FRACTURES

Tension-band wiring is the preferred method of treatment for olecranon fractures and is widely used throughout the world. This technique simply and effectively transforms the forces produced by the pulling of the triceps into forces causing compression of the fracture. Although the procedure is associated with a high union rate, the incidence of skin complications is also high. The most frequent complication is symptomatic prominence of the Kirschner wires (K-wires). The purpose of this retrospective study was to identify the optimal fixation of tension-band wiring in the treatment of olecranon fractures using biomechanical techniques. Sixty-two patients were divided into two groups: a bicortical Kirschner wire group and an intramedullary K-wire group. The migration rate of the K-wires and the union rate of fractured bone were measured in both groups. Achievement of radiographic union was similar in the two groups. However, the K-wire migration rate was higher in the intramedullary K-wire group than in the bicortical K-wire group. With appropriate surgical technique, the use of bicortical K-wires is biomechanically superior to the use of intramedullary K-wires in the treatment of olecranon fractures.

Congruent plate for treatment of displaced comminuted olecranon fractures

Objective To evaluate the clinical outcomes of congruent plate fixation for treatment of displaced comminuted olecranon fractures. Methods From February 2002 to July 2007, fifty-two patients with displaced comminuted olecranon fractures were treated with open reduction and congruent olecranon plate fixation. There were 37 male patients and 15 female patients, with a mean age of 37. 6 years. According to Mayo classification, there were 31 type Ⅱ B fractures and 21 type Ⅲ B fractures. Results All 49 cases were followed up for an average of 14.2 months (range 12 to 20 months). All fractures were healed within 3 months No wound infection was found in all cases. Three cases experienced symptomatic hardware irritation that was alleviated by hardware removal. The postoperative function was evaluated by Broderg and Morrey score system. In 30 cases of type Ⅱ B fractures, the results were excellent in 22 cases, good in 6 cases, and fair in 2 cases with 93.3% good or excellent rate. In 19 cases of type Ⅲ B fractures, the results were excellent in 6 cases, good in 8 cases, fair in 4 cases and bad in 1 case with 73.7% good or excellent rate. The difference in surgical outcomes between type Ⅱ B and type Ⅲ B fractures was statistically significance( P < 0.05). Conclusion Congruent plate fixation is an effective treatment option for displaced comminuted olecranon fractures with a good functional outcome. The classification system of Mayo can predict the functional outcome of displaced comminuted olecranon fractures. Key words: Fracture fixation, internal; Ulna; Fractures, comminuted

Clinical application of home-made absorbable screws in treatment of olecranon fractures

Objective To evaluate the results of internal fixation for olecranon fractures with home-made poly-DL-lactic acid (PDLLA) absorbable screws. Methods Fifty-four patients diagnosed as olecranon fracture were treated with internal fixation by PDLLA absorbable screws and tension band wiring respectively. In the experimental group, 22 patients were fixed using absorbable screws. In the control group,32 patients were fixed with tension band wiring. Results The follow-ups lasted for 7 to 49 (average,24. 8) months. All the fractures obtained solid union. The outcome was evaluated by Weseley rating system.The elbow function was good to excellent in 90.9 % of the patients in the experimental group, without pain or posterior apophysis of the elbow. Proximal radioulnar joint stiffness due to the screw was found in 1 patient,whose function of rotation recovered 5 months later. Invalid internal fixation was found by roentgenogram 2 weeks postoperatively in another 1 case who had been complicated with fractures of middle radius and ulna,and consequently had to be changed into tension band wiring. The elbow function recovered 12 months later.In the control group, the function was good to excellent in 93. 8%. Nine patients (28. 1% ) complained about posterior apophysis of the elbow and pain during motion. Roentgenogram revealed the K-wires backing out in 3 cases (9. 4% ). All the patients in this group had to have the internal fixators removed 8 to 15 months postoperatively. Data were statistically analyzed with SPSS 11.5. Rank sum test was used for pairwise comparison. There was no statistical significant difference in the good to excellent rate between the 2 groups ( W =845.0, P = 0. 485 ) . Conclusions Open reduction and internal fixation with home-made absorbable screws is an effective way for treatment of olecranon fractures. As the screws can be degraded completely,patients need not undergo a secondary operation, obviously reducing the treatment expenditure and time. Key words: Ulna fractures; Fracture fixation, internal; Absorbable screws

Protrusion of Hardware Impairs Forearm Rotation After Olecranon Fixation

Tension-band wire fixation is a common surgical technique that is used in the treatment of olecranon fractures and during osteotomies1-3. A number of problems that are specifically related to the use of Kirschner wires have been identified, including wire migration, skin ulceration, and the need for hardware removal4-6. We found only one published article that described diminished forearm rotation following the use of the tension-band technique7. Fig. 1 A patient with impaired forearm rotation after tension-band wire fixation of an olecranon osteotomy. A: The true lateral radiograph shows no evidence of undue penetration of the Kirschner wires into the soft tissues (arrow). B: Kirschner-wire protrusion (arrow) as seen in the three-dimensional model derived from the computed tomography scan. Impingement of the wires with the soft tissues is highly probable. We observed several instances of limitation of forearm rotation following tension-band wire fixation of the olecranon at our medical center (Division of Trauma Surgery, University Hospital of Zurich). Hence, we evaluated computed tomography scans of these patients and developed a computational simulation model with use of three-dimensional computed tomography reconstruction of the elbow. Unlike other authors who studied cadaver elbows3,6-9, we employed a virtual three-dimensional bone model to demonstrate the anatomy of the proximal aspect of the ulna and to simulate Kirschner-wire placement. One hundred and seventeen consecutive patients (seventy-one men and forty-six women) who had undergone internal fixation of the olecranon between April 2003 and November 2004 were retrospectively analyzed. The average age of the patients was 52.1 years (range, twenty-five to eighty-eight years). Of the 117 patients, forty-one underwent osteotomy of the olecranon for exposure of an intra-articular fracture of the distal aspect of the humerus and seventy-six had fixation of an olecranon fracture. The …

Surgical technique and preliminary results of a new fixation concept for olecranon fractures in children.

The authors report preliminary results of an original fixation technique used for the treatment of olecranon fractures in six children. This technique uses two threaded pins fitted with an adjustable lock, introduced through a minimal skin incision. With a mean follow-up of 14 months, clinical results are excellent in five cases and good in one case. Radiologic results are satisfying, with five anatomic reductions and without any secondary displacement. No growth impairment has been observed, but the follow-up period is still too short to conclude that this technique is superior, as far as this factor is concerned. However, the simplicity of the technique and its efficiency have led the authors to use it routinely for this fracture type.

AO tension band technique in the treatment of olecranon fractures

We evaluated the results of 35 olecranon fractures which were treated with AO tension band technique. The mean follow-up period was 46 months (min. 18 months) and the age average was 36 (18-80). Nineteen of the fractures were closed, and 16 of them were open. We used Schatzker classification system. According to this system, 11 of the fractures were transverse, 7 of them were transverse-impaction, 10 of them were oblique, 4 of them were comminuted, 2 of them were distal oblique and 1 of them was fracture-dislocation. The mean time between fractures and operation was 6.3 days (range 4 hours to 19 days). Mean time for beginning range of motion exercises was 10.7 days. The evaluation of the cases was based on Murphy's Scoring System which was related to pain, function, range of motion and roentgenogram. Mean score of all cases as to this system, was 17.2. Eighteen (%51) case were excellent, 15 (%43) of them were good, 1 (%3) cases were fair and 1(%3) case was poor. Overall treatment success rate was %94 (33 cases). Breakage of cerclage wire in 1(%3) case, migration of K-wire in 4(%11) cases were complicated. Discomfort due to fixation materials subcutaneously were the most common complications in 7(%20) cases. In 1 case (%3) myositis ossificans has developed. In the other 2 cases (%6) (1 case with comminuted fracture and 1 case with fracture-dislocation) pain, function and motion disability were evident. As a result, AO tension-band wiring is a useful technique in the treatment of transverse, impacted, oblique-distal and open fractures

The Effect of Tension Band Wiring in the Treatment of the Olecranon Fracture

Treatment of olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of tension band wiring, anatomical reduction was obtainable, and only a short period of immobilization was needed. We reviewed the cases of 17 patients who underwent surgical treatment of the olecranon fracture. All patients were treated by tension band wiring. In the over-all series, we were able to obtain 53 per cent excellent, 30 per cent good, and 17 per cent fair results.

Experience with the McAtee olecranon device in olecranon fractures.

Treatment of olecranon fractures by prolonged immobilization often results in limited elbow motion. With the use of a compression screw apparatus, anatomical reduction was obtainable, and only a short period of immobilization was needed. In a series of eleven fractures there were no non-unions and an average decrease in elbow range of motion of only 8 degrees.