Olecranon fractures: factors influencing re-operation

Purpose

We evaluated factors influencing re-operation in tension band and plating of isolated olecranon fractures.

Methods

Four hundred eighty-nine patients with isolated olecranon fractures who underwent tension band (TB) or open reduction internal fixation (ORIF) from 2003 to 2013 were identified at an urban level 1 trauma centre. Medical records were reviewed for patient information and complications, including infection, nonunion, malunion, loss of function or hardware complication requiring an unplanned surgical intervention. Electronic radiographs of these patients were reviewed to identify Orthopaedic Trauma Association (OTA) fracture classification and patients who underwent TB or ORIF.

Results

One hundred seventy-seven patients met inclusion criteria of isolated olecranon fractures. TB was used for fixation in 43 patients and ORIF in 134. No statistical significance was found when comparing complication rates in open versus closed olecranon fractures. In a multivariate analysis, the key factor in outcome was method of fixation. Overall, there were higher rates of infection and hardware removal in the TB compared with the ORIF group.

Conclusions

Our results demonstrate that the dominant factor driving re-operation in isolated olecranon fractures is type of fixation. When controlling for all variables, there is an increased chance of re-operation in patients with TB fixation.     

经双皮质克氏针张力带治疗尺骨鹰嘴骨折术后前臂旋后功能障碍

目的分析双皮质克氏针张力带法治疗尺骨鹰嘴骨折导致前臂旋后功能障碍的原因。方法2000年7月至今采用该方法治疗的尺骨鹰嘴骨折病人43例。通过对术中穿入克氏针时前臂的旋转位置、克氏针的穿入方式、克氏针穿出尺骨前方皮质的长度与前臂旋后范围的相关性加以分析,以确定该方法导致前臂旋后障碍的可能原因,并提出解决办法。结果该组病人前臂旋后功能的恢复明显较旋前功能恢复差,前臂处于旋前位和交叉穿针是导致该现象的主要原因。结论经双皮质克氏针张力带治疗尺骨鹰嘴骨折时,前臂旋后功能障碍的发生率较高。严格遵循手术操作规范可降低该并发症的发生率。     

Olecranon fractures in adults: factors influencing outcome

In a retrospective, non-randomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between 1 March 1992 and 1 March 2000. Medical records and X-rays of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, age and comorbidity were analysed. Radiological end result (intraarticular steps, gaps, arthrosis), subjective complaints, mobility of the elbow joint and muscle strength were evaluated. Patients with an unstable elbow (Mayo classification Type III and Schatzker-Schmeling classification Type D) had a higher loss of elbow function than others. There was a correlation between fracture morphology (fractures Type C and Type D in the Schatzker-Schmeling classification) and arthrosis. There also was a correlation between suboptimal osteosynthesis and arthrosis. There was no correlation between suboptimal osteosynthesis, implant loosening and secondary procedures. Patients more often expressed subjective complaints and loss of function in activities of daily life before than after metal removal. Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures. We, therefore, recommend the classification systems of the Mayo-clinic or of Schatzker-Schmeling. As many patients have complaints related to the implants, we recommend metal removal after fracture healing.     

Management of type IIB and IIIB olecranon fractures. Case series

Objectivesto report and evaluate the functional outcome of plate fixation in comminuted olecranon fractures (Mayo types IIB and IIIB).Method23 consecutive patients with comminuted fractures of the olecranon presenting to our unit Between Feb 2011 and Jan 2015, at a mean follow-up of thirty-six months. Main outcome measurements include radiographic healing, post-operative range of motion, complications, outcome score and patient satisfaction.ResultsOur study included thirteen females and ten males with a mean age of 55(18–97). Fourteen were Mayo type IIB and nine were Mayo type IIIB. Eighteen patients had no complications post-operatively with good outcome with mean oxford score of 45, full rotational ROM and mean flexion arc of 20–130 °. Five patients had range of motion between 40–90 ° with full rotational ROM and mean oxford score of 24. Two patients out of five required metal work removal. No non-unions were noted in our series.ConclusionPlate fixation of complex olecranon fracture is an effective, reliable method of treatment with low risk of non-union. Restoration of a functional flexion arc of movement can be expected with application of correct technique.     

Tension band wiring for olecranon fractures

Surgical Principles Anatomical reduction of fragments and internal fixation with 2 Kirschner wires and a tension band wire stable enough to allow early exercises. This technique permits dynamic compression of fragments and a speedy consolidation of the fractures.     

生物可吸收张力带治疗尺骨鹰嘴骨折

作者采用Biofix可吸收固定棒代克氏针和Biopoly人工韧带代钢丝形成可吸收张力带治疗尺骨鹰嘴骨折共18例,全部获随访,平均随访时间7.5个月,疗效判定以局部功能恢复情况和术后影像学综合判断。结果;优16例,良2例,差零例,术后未出现骨折或骨折再移位现象,无伤口感染。作者认为生物可吸收张力带具有无需二期手术,减少病人痛苦,简单方便,又不增加费用等优点,是治疗尺骨鹰嘴骨折较理想的方法。     

Posterior Olecranon Fracture Dislocations in Adults: A Systematic Review

Posterior olecranon fracture dislocations (POFDs) were considered posterior Monteggia lesions, which were less described in the literature. The purpose of this study was to provide a systematic review of the diagnosis, treatment, prognosis, and complications of POFDs in adults. A systematic review was performed to identify all relevant studies on the POFDs in the PubMed, Web of Science, Embase, and MEDLINE databases. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). A total of 117 patients were identified in the nine studies selected. The high-energy injuries accounted for 42.7% of the included studies. The rates of concomitant coronoid process, radial head fractures, and lateral collateral ligament injury were 84.6% (99/117), 87.2% (102/117), and 5% (6/117), respectively. The procedure was performed with a dorsal mid longitudinal approach to reconstruct all injury components. The postoperative clinical scores included the Broberg/Morrey rating, with a mean rating of excellent or good at 66%, the mean DASH score was 20.6, and the mean ASES score was 83. The flexion and extension arc and forearm rotation arcs were 100° and 134°, respectively. Complications included arthrosis in 28.2% (33/117) of cases, fracture nonunion or delayed union in 9.4% (11/117) of cases, heterotopic ossification in 7% (8/117) of cases, and the re-operation rate was 16% (19/117). There was nearly no postoperative ulnohumeral instability. The main characteristics of POFDs were disruptions of the trochlear notch, including the olecranon and coronoid processes, and severe radial head fractures, while the lateral collateral ligament was spared. Although the POFDs had a low frequency of instability, the prognosis was relatively poor. The POFDs should be considered independently.     

Humeral shaft fractures Intramedullary nail versus plate fixation

AelectronicsearchwasperformedtoidentifystudiespublishedfromMay1998toOctober2003comparingintramedullarynailingtoplatefixationforfracturesofthehumeralshaft.Fromalistof17articlesidentifiedfromthesearchstrategy,fourcomparedintramedullarynailingtoplatefixation.Twowererandomizedclinicaltrials,onewasacohortstudy,andonewasacaseserieswithahistoricalcontrol.Allareincludedinthisappraisal.Weexcludedstudiesevaluatingthesetreatmentsindelayedornonunions.StudiesforthiscaseStudy1McCormackRG,BrienD,Buckley…     

尺骨鹰嘴骨折两种治疗方法的疗效比较

目的：比较尺骨鹰嘴钢板和张力带治疗尺骨鹰嘴骨折的疗效。方法：采用2种方法治疗尺骨鹰嘴骨折63例，张力带内固定组（A组）35例，男21例，女14例；年龄15-62岁，平均48．9岁。尺骨鹰嘴钢板内固定组（B组）28例，男20例，女8例；年龄25～67岁．平均50．6岁。按Delee，JC（1984）分类方法，A组1A型5例，1B型8例，2型14例，3型7例，4型1例；B组1A型3例，1B型5例，2型6例，3型11例，4型3例。比较两组固定方法的疗效。结果：63例患者均获随访，时间6～15个月，参照庞桂根疗效评价标准，B组：优20例，良7例，可1例，差0例；A组：优23例，良10例，可2例，差0例。两种治疗方法疗效差异无统计学意义。结论：尺骨鹰嘴钢板和张力带都是治疗尺骨鹰嘴骨折的有效方法，可根据具体情况选择使用。     

Olecranon fractures: different surgical techniques

Numerous systems of osteosynthesis of olecranon fractures are avaible. The numero-ulnar articulation badly bears the smallest incongruence and easily faces rigidity. Therefore the aim of therapy is the anatomical and permanent reconstruction of the articular surface of the olecranon, in order to mobilize the elbow as soon as possible. We analyzed 85 olecranon fractures, classified according to Merle d'Aubignè and treated with two different surgical techniques (intramedullart screw and AO tension band wiring technique). The results were compared at an average follow-up of 88 months. Excellent clinical results were obtained in 74,12%, good in 29.00%, sufficient 3,53%, insufficient in 2,35% of patients, with a mean of recovery in 2 months and only 2 cases of pseudoarthrosis (with dynamic procedure). Objective results were similar for two techniques adopted, whereas the subjective results in patients with screw. The screw is more suitable in medio-olecranic and basis-olecranic fractures, while the dynamic procedure gives better results in fractures of the apex of olecranon and comminute fracture. Tolerance of the intramedullary screw has generally proved to be better (65% of cases), while the dynamic assembling has been removed in most cases after fracture consolidation. Periarticular calcifications correlated with the type of fracture (e. g. comminuted, associated) rather than with the means of synthesis employed. Received: 8 February 2001/Accepted: 4 September 2001     

A Simple and Safe Technique of Olecranon Osteotomy

Chevron osteotomy of the olecranon during the posterior approach of the elbow joint has become universally common. We modified the technique to see if it is better than the standard technique to perform, reconstruct and finally evaluate the results. A prospective study was done in 17 cases of comminuted distal humeral intercondylar fractures. A modified osteotomy was done using a Gigli saw instead of a power saw. The indications remained the same. After fixing the distal humerus fracture, the olecranon fragment was stabilised with tension band wire technique. The post-operative management was similar to that of standard AO technique. There were no per-operative difficulties with the new technique. The osteotomy was easy to do with no risk of damage to the distal humeral cartilage, as the direction of the osteotomy was away from the joint. Gigli saw produced congruent antero-posterior chevron surfaces which helped the fragment to sit well in its trough with good bony apposition. Stable reduction of the olecranon facilitated easy fixation. In this series, all osteotomies united well. There were no osteotomy-related complications. Two cases had prominent wires which were removed after the union of the osteotomy. We feel that this osteotomy is easy to perform, safe and takes less time than the standard technique, though a comparative study in a large number of cases by different surgeons needs to confirm the benefits.     

内外侧新型解剖型接骨板治疗肱骨髁间骨折

目的 介绍内外侧新型解剖型接骨板治疗肱骨髁间骨折的手术方法和疗效.方法 自2007年3月至2009年9月手术治疗肱骨髁间骨折35例,男27例,女8例;年龄21～87岁,平均46.2岁;左侧21例,右侧14例.骨折按照AO分型:C1型19例,C2型11例,C3型5例.经肱三头肌两侧入路或尺骨鹰嘴"V"形截骨2路,采用肱骨远端解剖接骨板治疗25例,采用肱骨远端解剖锁定接骨板治疗10例,术后早期积极进行功能锻炼.结果 所有患者术后获得6～24个月(平均14个月)随访,均获骨性愈合,术后未发生感染、内固定松动、异位骨化等并发症.肘关节平均屈伸81°(9～131°),屈曲110°(66～135°),伸直22°(0～75°).Mayo肘关节功能评分平均92分(62～100分),其中优20例,良10例,可4例,差1例,优良率为85.7%.疗效差的1例为C3型骨折合并颅脑外伤,术后未能及早行功能锻炼,造成肘关节僵硬.结论 采用内外侧新型解剖型接骨板治疗肱骨髁间骨折能获得坚强固定,有利于早期肘关节功能锻炼从而获得优良治疗效果.