Bilateral avulsion fractures of olecranon apophyses

Possible Mechanism and Treatment Results of Combined Pediatric Fractures of the Humeral Lateral Condyle and Ipsilateral Ulnar Olecranon

OBJECTIVE

Combined fractures of the lateral condyle of the humerus and the ipsilateral ulnar olecranon are rarely seen in children. Therefore, the mechanism and suitable treatments remain debatable. This study describes the possible mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures and presents the treatment results.

METHODS

Children diagnosed with combined fractures of the humeral lateral condyle and ipsilateralulnar olecranon from July 2010 to July 2020 were retrospectively analyzed. Humeral lateral condyle fractures were treated with open reduction and internal fixation with bioabsorbable pins. Ulnar olecranon fractures were treated with closed reduction and percutaneous pinning with K-wires for Mayo type IA fractures and with tension-band wiring or a locking plate for Mayo type IIA fractures. The postoperative function and appearance of the elbow were evaluated using the Flynn criteria and Mayo Elbow Performance Score (MEPS) at follow-up.

RESULTS

The cohort comprised 19 patients aged from 4 to 11 years. Bony compression and avulsion by attached muscles and ligaments may be the leading factors causing the combined injuries, as the children fell with an outstretched and supinated elbow. The average follow-up time was 33 months. High MEPS of >90 indicated that good to excellent results were obtained without complications.

CONCLUSIONS

This study proposed a reasonable hypothesis for the mechanism of combined humeral lateral condyle and ipsilateral ulnar olecranon fractures in children. Satisfactory outcomes were achieved with bioabsorbable pins for lateral condyle fractures and closed reduction and percutaneous pinning with K-wires, tension-band wiring, or locking plate for olecranon fractures.

Traumatic pediatric olecranon injury: a report of suture fixation and review of the literature

Elbow injuries make up to 3% to 4% of all emergency department presentations and are often difficult to diagnose. These injuries are often missed on radiographs because of the large cartilaginous component of the pediatric elbow resulting in malunion. Fractures around the elbow joint are one of the leading causes of litigation claim, and awareness of the pitfalls in diagnosis of these subtle injuries is necessary for a prompt diagnosis. Fracture of the olecranon epiphysis is rare and often being described around puberty and in association with osteogenesis imperfecta. Management using K-wire tension band fixation has been described in the past, which can lead to growth arrest in younger patients.We hereby present a missed rare sleeve-type open olecranon epiphyseal fracture in a young child, highlighting the pitfalls in the diagnosis of these injuries. This article also reviews various options to manage such a rare fracture and also suggests an alternative method of transosseous suture fixation with an excellent result.

Displaced fractures of the apophysis of the olecranon in children who have osteogenesis imperfecta

Seven fractures of the apophysis of the olecranon in five children who had mild osteogenesis imperfecta were treated with open reduction and internal fixation followed by immobilization in a cast. All of the fractures healed uneventfully. The patients were examined after an average duration of follow-up of thirty months (range, twelve to sixty months); at that time, no patient reported pain or limitation of function. In the four elbows that had been followed for three years or more, there had been no observable disturbance of growth.

Avulsion Fracture of the Olecranon Process

In brief A young wrestler with an avulsion fracture of the olecranon process was treated conservatively without success. Internal fixation was done, but when no improvement was demonstrated at follow-up, a removable cast was used so that he could do range-of-motion exercises to facilitate healing. This case demonstrates that young patients who complain of elbow pain should be followed carefully because of possible damage to the epiphysis.