尺骨上段合并鹰嘴骨折内固定的生物力学研究

目的比较克氏针张力带、重建钢板联合张力带及鹰嘴解剖钢板固定尺骨上段合并鹰嘴骨折3种方式的生物力学稳定性,为临床选择内固定提供理论依据。方法 8个自愿捐献的新鲜成人尸体肘关节标本,均为男性;年龄26～43岁,平均34.8岁。于尺骨上段及尺骨鹰嘴分别截骨制作尺骨上段合并鹰嘴骨折模型。每个标本分别采用克氏针张力带(A组)、重建钢板联合张力带(B组)及鹰嘴解剖钢板(C组)3种方式对骨折端固定。采用生物力学测试系统进行单轴压缩试验,记录载荷-位移曲线,内固定系统的稳定性采用骨折端压缩位移为2 mm时所加的载荷值进行评价。结果实验过程中未出现克氏针退出、钢板螺钉断裂、标本破坏,标本与夹具固定无松动。3组标本均表现为位移随载荷增加而逐渐增长,但B、C组的载荷-位移曲线斜率明显高于A组。当骨折端压缩位移为2 mm时,A、B、C组的所加载荷值分别为(218.6±66.9)、(560.3±116.1)、(577.2±137.6)N,B、C组所加载荷值均显著高于A组,差异有统计学意义(P<0.05);B、C组间差异无统计学意义(t=0.305,P=0.763)。结论尺骨上段合并鹰嘴骨折多为不稳定骨折,重建钢板联合张力带、鹰嘴解剖钢板固定均能满足要求,临床上可根据患者情况合理选用。克氏针张力带固定不够牢固,临床上应避免单独使用。     

Pediatric olecranon fractures: open reduction and internal fixation with removable Kirschner wires and absorbable sutures

The authors present an original fixation technique for pediatric olecranon fractures that avoids reoperation to remove hardware as compared with the standard fixation technique with Kirschner wires and tension band wiring as advocated by the AO technique. The authors' technique uses two percutaneously placed Kirschner wires to fixate displaced transverse and oblique olecranon fractures. Prior to the insertion of the wires, the fracture is reduced through a standard open approach. Augmentation of the pin fixation is achieved with absorbable sutures. Six patients have been treated with this technique, with a mean follow-up of 13 months. No immediate complications have been noted; one patient has a loss of extension of 10 degrees at the elbow. Radiographic results are good, with no loss of reduction. This technique avoids the need for reoperation for hardware removal without compromising the quality of reduction.     

The olecranon sled—a new device for fixation of fractures of the olecranon: A mechanical comparison of two fixation methods in cadaver elbows

Background?Tension band wiring is the most common surgical procedure for fixation of fractures of the olecranon, but symptomatic hardware prominence and migration of K-wires can cause a high re-operation rate. The olecranon sled has been designed to minimize some of these problems.

Material and methods?Simulated olecranon fractures were created in 6 matched pairs of cadaver arms. Each pair was fixed with tension band wiring used on the one arm and the olecranon sled being used on the other. Mechanical testing was done with the humerus rigidly fixed in a vertical position while the forearm was held at 1 of 3 angles of elbow fixation, 45°, 90° and 135°, respectively. For each angle, the triceps and the brachialis muscles were sequentially loaded with 5?kg (50?N) for 20 cycles and the amount of fracture displacement measured.

Results?Loading of the brachialis muscle produced no increase in the fracture gap for either of the two fixation techniques. However, an increase in the fracture gap of up to 0.23?mm was found after cyclic loading of the triceps muscle for both techniques. The amount of increase was not significantly different between the two techniques.

Interpretation?The olecranon sled appears to provide as stable fixation as tension band wiring for olecranon fractures.     

The olecranon sled--a new device for fixation of fractures of the olecranon: a mechanical comparison of two fixation methods in cadaver elbows

Background Tension band wiring is the most common surgical procedure for fixation of fractures of the olecranon, but symptomatic hardware prominence and migration of K-wires can cause a high re-operation rate. The olecranon sled has been designed to minimize some of these problems.

Material and methods Simulated olecranon fractures were created in 6 matched pairs of cadaver arms. Each pair was fixed with tension band wiring used on the one arm and the olecranon sled being used on the other. Mechanical testing was done with the humerus rigidly fixed in a vertical position while the forearm was held at 1 of 3 angles of elbow fixation, 45°, 90° and 135°, respectively. For each angle, the triceps and the brachialis muscles were sequentially loaded with 5 kg (50 N) for 20 cycles and the amount of fracture displacement measured.

Results Loading of the brachialis muscle produced no increase in the fracture gap for either of the two fixation techniques. However, an increase in the fracture gap of up to 0.23 mm was found after cyclic loading of the triceps muscle for both techniques. The amount of increase was not significantly different between the two techniques.

Interpretation The olecranon sled appears to provide as stable fixation as tension band wiring for olecranon fractures.     

Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon

Compression and absolute stability are important in the management of intra-articular fractures. We compared tension band wiring with plate fixation for the treatment of fractures of the olecranon by measuring compression within the fracture. Identical transverse fractures were created in models of the ulna. Tension band wires were applied to ten fractures and ten were fixed with Acumed plates. Compression was measured using a Tekscan force transducer within the fracture gap. Dynamic testing was carried out by reproducing cyclical contraction of the triceps of 20 N and of the brachialis of 10 N. Both methods were tested on each sample. Paired t-tests compared overall compression and compression at the articular side of the fracture. The mean compression for plating was 819 N (sd 602, 95% confidence interval (CI)) and for tension band wiring was 77 N (sd 19, 95% CI) (p = 0.039). The mean compression on the articular side of the fracture for plating was 343 N (sd 276, 95% CI) and for tension band wiring was 1 N (sd 2, 95% CI) (p = 0.038). During simulated movements, the mean compression was reduced in both groups, with tension band wiring at -14 N (sd 7) and for plating -173 N (sd 32). No increase in compression on the articular side was detected in the tension band wiring group. Pre-contoured plates provide significantly greater compression than tension bands in the treatment of transverse fractures of the olecranon, both over the whole fracture and specifically at the articular side of the fracture. In tension band wiring the overall compression was reduced and articular compression remained negligible during simulated contraction of the triceps, challenging the tension band principle.     

The role of cancellous screw with tension band fixation in the treatment of displaced olecranon fractures,a comparative study

Introduction  Fractures of the olecranon are among the most common injuries involving the upper extremity and require operative intervention if displaced. The most commonly used method of fixation for this type of fracture is the AO tension band wiring, although the results of this technique have been generally good, still problems have occurred, including loss of fixation, nonunion, and high re-operation rate for hardware removal. Aim of the study  To compare the results of treatment of displaced fractures of the olecranon using AO tension band wiring versus intramedullary screw with tension band. Materials and methods  In a prospective study, 30 patients with transverse or oblique olecranon fractures, were randomly divided into two equal groups, one group treated using AO tension band wiring the other group using an intramedullary cancellous screw plus tension band. Results  In the screw plus tension band group, 11 (73.3%) patients had excellent results, four (26.7%) had good results and none had fair or poor results, only one(6.6%) patient required second operation for removal of prominent hardware. In the AO tension band group, six (40%) patients had excellent results, five (33.3%) had good, three (20%) had fair and one (6.7%) patient had poor result, and eight patients (53.3%) required second operation for removal of prominent hardware. Conclusion  Using an intramedullary screw combined with tension band in treatment of displaced transverse and oblique olecranon fractures gives better clinical results and has much less re-operation rate for removal of hardware when compared to AO tension band wire fixation, avoiding costs, work time loss and possible complications from hardware removal.     

Operative treatment of olecranon nonunion.

Records of five patients treated surgically for nonunion of the olecranon were reviewed. Four of the five fractures leading to nonunion were comminuted or oblique. Three nonunions occurred after tension band wiring, one nonunion occurred after open reduction internal fixation with a semitubular plate, and one nonunion occurred after treatment with a cast. The median interval from fracture to treatment of nonunion was 8 months. All nonunions were treated surgically. Four patients were treated with a tension band plate technique. All nonunions united at a median of 3 months. The median follow-up period was 36 months (range, 12-48 months).     

Pyrford钢丝环扎张力带内固定治疗髌骨骨折的生物力学分析及临床研究

[目的] 测试Pvrford钢丝环扎加张力带内固定治疗髌骨骨折的生物力学特性，为临床治疗提供理论依据。[方法] 采集新鲜牛尸体膝关节标本，制成髌骨骨折模型，用Pyrford钢丝环扎加张力带固定，并与克氏针张力带、单纯钢丝环扎进行对照比较。[结果]Pyrford钢丝环扎加张力带内固定其强度和刚度相当于传统的8字形克氏针张力带，而且髌骨的应变、位移很小。临床应用Pyrford钢丝环扎加张力带内固定治疗髌骨骨折105例，随访6～23个月，优良率达98％。[结论]Pyrford钢丝环扎加张力带固定完全符合髌骨的生物力学性能，且能达到解剖复位，操作简便，固定牢固，适应早期功能锻炼的目的。     

Tension band wiring of olecranon fractures. A modification of the AO technique.

One of the weaknesses of the tension band wiring technique for the treatment of olecranon fractures is that it may open up the fracture at the articular surface of the ulna. A simple modification of the technique eliminates this problem by converting the distracting forces at the articular surface of the joint to compressive forces.     

尺骨鹰嘴骨折皮质骨加压螺钉固定的实验研究及临床应用

比较尺骨鹰嘴骨折加压螺钉与常用的4种内固定的强度,为临床选择内固定方法提供实验依据。用22具新鲜尸体肘关节做成横型、斜形和粉碎形鹰嘴骨折模型。用5种内固定后置于MD—10E万能电子力学试验机上,测定骨折处的位移与压力的关系;结果:钢丝内固定强度最小,钩钢板最大。髓内加压螺钉固定欠可靠。横形骨折皮质骨加压螺钉与张力带钢丝比较,统计学上无显著差异(P〉0.05),斜形骨折皮质骨加压螺丝钉强于张力带钢丝(P〈0.01)。粉碎形骨折使用钩钢板尤佳(P〈0.01)。临床应用24例中,22例平均随访14个月。骨折全部愈合,优良率达90.91％;认为皮质骨加压螺丝钉治疗横、斜形尺骨鹰嘴骨折,创伤小,操作简便,固定确切,是一种安全可靠的方法。     

不同类型尺骨鹰嘴骨折的内固定选择

目的 探讨不同类型尺骨鹰嘴骨折内固定的选择策略.方法 对2007年2月至2009年11月不同手术方法治疗的62例尺骨鹰嘴骨折患者资料进行回顾性分析,其中张力带固定组36例,男17例,女19例,平均42.7岁;骨折按照Schatzkeer分型:A型13例,B型8例,C型10型,D型3例,E型1例,F型1例;采用克氏针张力带(28例)及Cable-Pin(8例)固定;钢板固定组26例,男11例,女15例,平均43.9岁;骨折按照Schatzkeer分型:A型8例,B型6例,C型7型,D型2例,E型1例,F型2例;采用普通解剖钢板或锁定接骨板固定.采用Broberg-Morrey肘关节评分评定功能,并比较两组患者的优良率.结果 本组患者术后获得6～24个月(平均11个月)随访.术后6个月Broberg-Morrey肘关节评分,张力带组:优14例,良16例,可4例,差2例,优良率83.3%;钢板组:优11例,良11例,可3例,差1例,优良率84.6%,两组优良率比较差异无统计学意义(χ2=1.484,P=0.361).张力带组有5例患者发生骨折复位丢失,其中B型3例,C、D型各1例;钢板组随访期间无内固定松动、无骨折移位,但D、F型各有1例患者出现骨化性肌炎.结论 张力带技术对于简单移位骨折固定可靠,但粉碎性、斜行及脱位型骨折则适用钢板固定.     

可吸收张力带在尺骨鹰嘴或内踝骨折中的应用

目的介绍可吸收螺钉和可吸收线组成可吸收张力带固定尺骨鹰嘴或内踝骨折的方法及疗效。方法将尺骨鹰嘴或内踝骨折复位，以1枚可吸收螺钉将尺骨鹰嘴与尺骨干或内踝与胫骨固定，骨干与螺钉尾部以可吸收线作张力带固定。结果可吸收张力带固定尺骨鹰嘴骨折59例，内踝骨折43例，固定牢靠，功能恢复良好。结论可吸收张力带固定尺骨鹰嘴骨折或内踝骨折操作简便，疗效满意，并发症少，无需二次手术取内置物。     

Surgical treatment of displaced olecranon fractures by tension band wiring technique

Forty-five displaced olecranon fractures including 14 accompanying dislocated radial heads and seven radial head fractures were treated over a 13-year period by the tension band wiring technique. The use of supplemental internal fixation when necessary allows excellent results with the use of this technique, even in the presence of severe comminution or radial head dislocation. Primary silicone radial head implants fractured in all three patients in which they were used, necessitating repeat surgery in two patients to date. While loss of motion in terminal extension was a common aftermath of displaced olecranon fracture (59%), it was usually minor and functionally insignificant. True Kirschner-wire migration was not a common problem and can probably be eliminated by proper technique. The presence of gaps in the intraarticular surface of the semilunar notch of the ulna produced no ill effects and was compatible with excellent results. If only those cases with isolated olecranon fractures in this series are considered, there were good and excellent results in 29 of 30 cases (97%). Excision of the olecranon fragment(s) should be reserved for those cases when anatomic restoration cannot be achieved with internal fixation.     

A survey of current practices and preferences for internal fixation of displaced olecranon fractures

Background

Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons’ practices and preferences for internal fixation methods for displaced olecranon fractures.

Methods

Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures.

Results

We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5–37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73–83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5–85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17–3.45) and comminution with a mean impact of 3.34 (95% CI 3.21–3.46) were the 2 factors influencing surgeons’ choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69–80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4–81.7%) and 76.2% (95% CI 70.6–81.0%) for tension band wiring and plating, respectively.

Conclusion

Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures.     

Posterior olecranon plating: biomechanical and clinical evaluation of a new operative technique

The purpose of this investigation was to compare the biomechanical analysis of a new plating technique for olecranon fractures to tension band wiring, and review early clinical results. Six matched pairs of cadaveric ulnae were used for the biomechanical analysis. A transverse osteotomy of the mid part of the olecranon was made. One ulna of each pair was stabilized using a tension band and the other with a posterior hook plate. The ulnae were mounted and loaded, and displacement at the osteotomy site recorded. Twenty patients treated with this new technique (14 fractures and 6 osteotomies) were reviewed at one year (range: 8 to 18 months) for infection, union rate, hardware related complaints. and removal. Statistical analysis showed significantly less displacement occurred at the osteotomy site in the plating group. Clinically, all patients had fracture union, and there were no hardware related problems. Posterior plating with this technique achieves greater stability compared to tension band wiring. Early clinical results indicate a low level of hardware related complications.     

Modified tension band wiring fixation for avulsion fractures of the calcaneus in osteoporotic bone: a review of three patients

Calcaneal avulsion fractures are not uncommon, and they are probably more likely in patients with osteoporosis. Closed manipulation for this type of fracture often fails to achieve acceptable reduction, and open reduction and internal fixation are usually required. However, open reduction and internal fixation with either a lag screw or Steinmann pins do not provide satisfactory fixation in patients with diabetes and elderly patients because of the presence of porotic bone. Levi described a tension band fixation system used to treat a calcaneal avulsion fracture using a simple technique performed with a transverse Kirschner wire through the os calcaneus, securing a figure-of-8 metal tension band wiring to the fragment. We report the successful treatment of 3 patients with calcaneal avulsion fractures using a modified tension band wiring technique, resulting in satisfactory recovery. Re-displacement of the fragment during the initial follow-up period was not reported, and bony union was achieved in all patients. We believe this technique is a useful surgical option for the treatment of calcaneal avulsion fractures.     

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。     

微型螺栓张力带钢丝髌骨内固定装置的临床应用

为改进传统的克氏针张力带钢丝内固定技术并在此基础上设计成微型螺栓张力带钢丝髌骨内固定装置。对35例髌骨骨折病人进行应用。所有病人均得到6～32个月的随访,病人的疗效优良率达97.1％;骨折愈合率达100％。未发现有针尾触痛、针端戳破皮肤、内固定物松动、脱落等现象。认为该装置固定牢固,使用安全,疗效确切,符合髌骨骨折内固定的生物力学要求。其优点在于减少传统克氏针张力带钢丝内固定的并发症,使髌骨骨折的内固定技术更趋完善。     

Surgical treatment of olecranon fractures

Fractures of the olecranon are common injuries with no single accepted treatment. Numerous clinical factors and biomechanical studies guide the surgeon in determining a treatment plan. The goals of surgical management include anatomical reduction and stable fixation, which allow early range of motion of the elbow joint. Numerous fixation methods have been described and include screw fixation, cerclage wiring, modified tension-band wiring, and plate fixation. The surgical technique depends on a combination of patient factors, the fracture pattern, and the mechanical stability of the fixation construct. Postoperative rehabilitation includes early active range-of-motion exercises and follows clinical and radiographic healing. Complications are related to the fracture, choice of implant, and surgical technique.     

Methods of fixation of olecranon fractures. An experimental mechanical study

This study was designed to compare the rigidity of the more commonly used techniques of internal fixation of fractures of the olecranon. Cadaveric elbow joints were mounted in a jig and controlled osteotomies performed to simulate transverse, oblique or comminuted fractures. Five techniques of internal fixation were tested by measuring movement at the fracture site after applying a bending moment to the ulna. At transverse osteotomies tension-band wiring with two tightening knots allowed least movement even at high loads. Intramedullary cancellous screw fixation gave erratic results; adding a tension band with a single know was little better. In oblique osteotomies, no statistically significant difference was shown between one-third tubular plate fixation and double-knot wiring. Comminuted osteotomies were held most rigidly by contoured one-third tubular plate fixation.