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Luppi V, Regis D, Maluta T, Sandri A, Trivellato A, Mirabile A, Magnan B. Conservative versus surgical treatment for displaced olecranon fractures in the elderly: a retrospective study and a review of the literature. Musculoskelet Surg 2024:10.1007/s12306-024-00853-x. [PMID: 39085686 DOI: 10.1007/s12306-024-00853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND 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. MATERIALS AND METHODS Sixteen and eleven patients aged ≥ 75 years (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. RESULTS At an average follow-up of 26.5 months 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%). CONCLUSIONS Displaced olecranon fractures can successfully be treated conservatively in low-demand geriatric patients with good functional results and high satisfaction rate.
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Affiliation(s)
- V Luppi
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy.
| | - D Regis
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
| | - T Maluta
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
| | - A Sandri
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
| | - A Trivellato
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
| | - A Mirabile
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
| | - B Magnan
- Department of Orthopedics and Traumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale A. Stefani n. 1, 37126, Verona, Italy
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Egenolf P, Ott N, Babasiz T, Hackl M, Mueller LP, Wegmann S. Early range of motion results in good elbow function following conservative treatment of non-displaced radial head fractures. Arch Orthop Trauma Surg 2024; 144:2165-2169. [PMID: 38613615 PMCID: PMC11093790 DOI: 10.1007/s00402-024-05293-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the range of motion (ROM), elbow function and predictors for good elbow function after conservative treatment of non-displaced radial head fractures. MATERIAL AND METHODS All patients with non-displaced radial head fractures (displacement < 2 mm), that were diagnosed between January 1st 2017 and December 31st 2021 in a level I trauma center, were included in this retrospective case series and the charts were evaluated for ROM and elbow function. Elbow function was categorized as "good" or "bad" depending on the ROM measured defined by Morrey et al. Overall, 73 patients (33 male, 40 female) with an average age of 38 years (+/- 13 years) could be included. RESULTS Conservative treatment had good clinical results for ROM and elbow function. After 6 weeks mean flexion was 131° (SD 13°), extension 8° (SD 7°), Pronation 83° (SD 11°) and Supination 83° (SD 13). Patients with a good elbow function after one week showed a good elbow function after completing the treatment. CONCLUSIONS A clinical assessment after one week should always be performed and the study showed that it is a good predictor for good elbow function. In cases of bad elbow function further controls should be considered.
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Affiliation(s)
- Philipp Egenolf
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
| | - Nadine Ott
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Tamara Babasiz
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Michael Hackl
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Lars-Peter Mueller
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Sebastian Wegmann
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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Carminati F, Obert L, Saade F, Bouteille C, Woussen E, Aouzal Z, Bourgeois M, Haight H, Regas I, Rochet S, Lepage D, Garbuio P, Loisel F. Reproducibility of the Mayo and Schatzker classification systems in proximal ulna fractures. Orthop Traumatol Surg Res 2024; 110:103790. [PMID: 38070730 DOI: 10.1016/j.otsr.2023.103790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 04/29/2024]
Abstract
INTRODUCTION A fracture classification system should provide a reliable and reproducible means of communication between different parties. It should be logical and understandable, with few categories to memorize. The aim of this study was to determine the intra- and interobserver reliability of the Schatzker and Mayo classification systems for the assessment of proximal ulna fractures. MATERIALS AND METHODS Intra- and interobserver reliability studies were conducted on 39 X-rays of injured elbows drawn randomly from 74 cases previously used in a series on predictors of ulnohumeral osteoarthritis in proximal ulna fractures. Ten observers independently reviewed these X-rays on 2 separate occasions 3 months apart. The fracture type was assessed according to the Schatzker and Mayo classification systems during each reading session. Cohen's and Fleiss' kappa were used to measure the intra- and interobserver reliability. RESULTS The Schatzker classification had a fair interobserver reliability for the first (Schatzker R1, Fleiss' κ: 0.394) and second (Schatzker R2, Fleiss' κ: 0.351) readings. The mean intraobserver reliability value between the 10 reviewers for the Schatzker classification was rated as substantial (0.61). The Mayo classification had a fair interobserver reliability for the first (Mayo R1, Fleiss' κ: 0.278) and second (Mayo R2, Fleiss' κ: 0.292) readings. The mean intraobserver reliability value between the 10 reviewers for the Mayo classification was rated as fair (0.52). DISCUSSION The classification systems for proximal ulna fractures showed poor reproducibility between the different observers since they had low interobserver agreement values. Nevertheless, their use remained reliable since the measured intraobserver agreement value was deemed substantial. LEVEL OF EVIDENCE IV; retrospective.
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Affiliation(s)
- Fabio Carminati
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France.
| | - Laurent Obert
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - François Saade
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Camille Bouteille
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Edouard Woussen
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Zouhair Aouzal
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Michaël Bourgeois
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Harrison Haight
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Inès Regas
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Séverin Rochet
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Daniel Lepage
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Patrick Garbuio
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - François Loisel
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
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Zhao Y, Tian H, Yin N, Du L, Pan M, Ding L. The effect of Ding's screws and tension band wiring for treatment of olecranon fractures: a biomechanical study. Sci Rep 2024; 14:9999. [PMID: 38693300 PMCID: PMC11063218 DOI: 10.1038/s41598-024-60264-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/21/2024] [Indexed: 05/03/2024] Open
Abstract
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.
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Affiliation(s)
- Yong Zhao
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China
| | - Hongbo Tian
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China
| | - Nuo Yin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China
| | - Li Du
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China
| | - Mingmang Pan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China
| | - Liang Ding
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, 201400, China.
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Chen C, Zhang J, Cao R, Hua K, Zha Y, Gong M, Jiang X. Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures. Heliyon 2024; 10:e29184. [PMID: 38628716 PMCID: PMC11019171 DOI: 10.1016/j.heliyon.2024.e29184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Background Tension 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. Methods The 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. Results Thirty-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. Conclusion Olecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.
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Affiliation(s)
- Chen Chen
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Jianyu Zhang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Renwei Cao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Kehan Hua
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yejun Zha
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Maoqi Gong
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
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Khanna A, Clark CJ, Yuan BJ, Tangtiphaiboontana J, Barlow JD. Omega Plate Fixation of Comminuted Olecranon Fractures: Technique and Case Series. Tech Hand Up Extrem Surg 2024:00130911-990000000-00096. [PMID: 38556901 DOI: 10.1097/bth.0000000000000480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
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.
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Affiliation(s)
- Ankur Khanna
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Clarence J Clark
- Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Brandon J Yuan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Rantalaiho IK, Laaksonen I, Kostensalo J, Ekman EM, Ryösä AJ, Äärimaa VO. Mortality and subsequent fractures of patients with olecranon fractures compared to other upper extremity osteoporotic fractures. Shoulder Elbow 2024; 16:186-192. [PMID: 38655414 PMCID: PMC11034465 DOI: 10.1177/17585732221124301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/23/2022] [Accepted: 08/17/2022] [Indexed: 04/26/2024]
Abstract
Background The incidence rate of olecranon fractures is highest in the elderly population. The aim of this study was to determine whether patients with olecranon fractures have similar demographic and risk characteristics compared to patients with osteoporotic upper extremity fractures. Methods A retrospective data analysis was performed with diagnoses for olecranon fracture, distal radius fracture and proximal humerus fracture between 2014 and 2016. Results A total of 157 olecranon, 1022 distal radius and 451 proximal humerus fractures were identified. The risk of mortality after olecranon and distal radius fractures was comparable but statistically significantly higher after proximal humerus fractures (HR 1.97, 95% CI 1.19-3.27). The risk of subsequent osteoporotic fractures after an olecranon fracture was 10% at 1 year and 14% at 5 years and the risks did not differ statistically after a proximal humerus fracture, 6% and 11% (HR 0.65, 95% CI 0.40-1.06). After a distal radius fracture, the risks were statistically significantly lower: 2% and 5% (HR 0.35, 95% CI 0.22-0.56). Discussion Patients with olecranon fractures have essentially similar demographic characteristics compared to patients with distal radius fractures, but the probability for a subsequent fracture is significantly higher and more comparable to patients with proximal humerus fractures.
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Affiliation(s)
- Ida K Rantalaiho
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- University of Turku, Department of Clinical Medicine, Turku, Finland
| | - Joel Kostensalo
- Natural Resources, Natural Resources Institute Finland (Luke), Joensuu, Finland
| | - Elina M Ekman
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Anssi J Ryösä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Ville O Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- University of Turku, Department of Clinical Medicine, Turku, Finland
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Gutman MJ, Kirsch JM, Koa J, Fares MY, Abboud JA. Midterm outcomes of suture anchor fixation for displaced olecranon fractures. Clin Shoulder Elb 2024; 27:39-44. [PMID: 38062721 PMCID: PMC10938017 DOI: 10.5397/cise.2023.00528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures. METHODS A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed. RESULTS Suture anchor fixation was performed on 17 patients with displaced olecranon fractures. Functional outcome scores were collected from 12 patients (70.6%). The mean age at the time of surgery was 65.6 years, and the mean follow-up was 5.6 years. Sixteen of 17 patients (94%) achieved osseous union in an acceptable position. No hardware-related complications or fixation failure occurred. Mean postoperative shortened disabilities of the arm, shoulder, and hand (QuickDASH) score was 3.8±6.9, and mean Oxford Elbow Score was 47.5±1.0, with nine patients (75%) achieving a perfect score. CONCLUSIONS Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. Additionally, this technique resulted in high rates of osseous union without any hardware-related complications or fixation failures. Level of evidence: IV.
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Affiliation(s)
- Michael J. Gutman
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jacob M. Kirsch
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jonathan Koa
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mohamad Y. Fares
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Saremi H, Shirouei S, Shojaie B. Sliding Osteotomy, a New Simple Technique for Olecranon Nonunion Treatment. Tech Hand Up Extrem Surg 2024; 28:9-11. [PMID: 37589338 DOI: 10.1097/bth.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
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.
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Affiliation(s)
- Hossein Saremi
- Department of Orthopedic Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Sepehr Shirouei
- Department of Orthopedic Surgery, Besat Hospital, Hamadan University of Medical Sciences, Hamedan, Iran
| | - Babak Shojaie
- Department of Plastic and Reconstructive Surgery, Klinikum Bremen Mitte, Gottingen University of Medical Science, Bremen, Germany
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Woolnough T, Caines AM, Pollock JW, Papp SR. Treatment of olecranon fractures in older individuals: a cross-sectional survey of surgeon treatment preferences. JSES Int 2024; 8:227-231. [PMID: 38312299 PMCID: PMC10837697 DOI: 10.1016/j.jseint.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background With an aging population, the incidence of olecranon fractures in older patients is increasing. The standard of care has traditionally included operative management for displaced fractures. Recent literature has called this standard of care into question. Older patients may be at increased risk of operative complications and may have satisfactory functional outcomes with nonoperative management. Given recently evolving evidence, the current treatment preferences of orthopedic surgeons for older patients with displaced olecranon fractures are unknown. Methods We administered a cross-sectional survey of Canadian orthopedic surgeons via e-mail invitation and online survey form to determine treatment preferences for patients aged 65-75 and >75 years with simple displaced and comminuted displaced stable olecranon fractures. Respondents reviewed representative images and were asked to indicate their preferred treatment based on patient age. We also asked respondents to indicate their perceived importance of 11 patient factors on treatment decision-making. Results We received 200 responses (33.8% response rate). For patients aged 65-75 years with simple displaced fractures, surgeons preferred tension-band wiring (n = 110, 56%) to plating (n = 82, 42%, P = .005), while only 3% (n = 5) preferred nonoperative treatment. For patients aged >75 years with simple displaced fractures, surgeons preferred operative (n = 144, 73%) to nonoperative management (n = 51, 26%; P < .01) with either tension-band wiring (n = 77, 39%) or plating (n = 67, 34%). In these patients, early range of motion (n = 35, 18%) was preferred to immobilization (n = 16, 8%; P = .004). For comminuted fractures, plate fixation was preferred for patients aged 65-75 years (n = 189, 95%) and >75 years (n = 131, 68%). In patients aged >75 years, this was followed by early range of motion (n = 35, 18%) and immobilization (n = 24, 13%). Of the 11 factors surveyed, participation in high-intensity activities (mean rank = 9.4), independent living (mean rank = 8.8), and disrupted extensor mechanism (mean rank = 8.3) were ranked most highly for increasing likelihood of surgical treatment. Conclusion In patients aged 65 to 75 years, operative management is favored by most surgeons, with tension-band wiring preferred over plating for simple displaced fractures. In patients aged >75 years, operative management is again preferred by most respondents for simple and comminuted fractures. Despite operative preferences, there is a paucity of quality evidence to guide treatment decision-making, particularly in patients aged >75 years.
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Affiliation(s)
- Taylor Woolnough
- Division of Orthopaedic Surgery, The Ottawa Hospital – Civic Campus, Ottawa, ON, Canada
| | - Andrew M. Caines
- Division of Orthopaedic Surgery, The Ottawa Hospital – Civic Campus, Ottawa, ON, Canada
| | - JW. Pollock
- Division of Orthopaedic Surgery, The Ottawa Hospital – General Campus, Ottawa, ON, Canada
| | - Steven R. Papp
- Division of Orthopaedic Surgery, The Ottawa Hospital – Civic Campus, Ottawa, ON, Canada
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Zhang S, Lian Z, Ge J. Gout associated with the olecranon fracture: A case report. Asian J Surg 2024; 47:552-553. [PMID: 37783624 DOI: 10.1016/j.asjsur.2023.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Shaobing Zhang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China; Department of Orthopaedics, The First People's Hospital of Ziyang, Ziyang, 641300, PR China
| | - Zhi Lian
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China
| | - Jianhua Ge
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, PR China; Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, 646000, PR China.
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12
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Schwartz JM, Taleghani ER, Yildirim B, Novicoff W, Freilich AM. Timing of Olecranon Fracture Fixation Does Not Affect Early Complication or Reoperation Rates. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:53-57. [PMID: 38313620 PMCID: PMC10837298 DOI: 10.1016/j.jhsg.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 02/06/2024] Open
Abstract
Purpose Surgical fixation of olecranon fractures can lead to soft-tissue complications and return to the operating room for hardware removal. While some risk factors of complications after olecranon fracture fixation have been described, the effects of fixation timing on complications and reoperation have not been evaluated. The purpose of the present study was to assess whether the timing of olecranon fracture fixation affects complication and reoperation rates. Methods All patients who underwent olecranon fracture open reduction and internal fixation at a single level 1 trauma center from January 2012 to February 2022 were included in the study. A retrospective review was performed to evaluate patients for inclusion and to identify patient demographic factors, medical comorbidities, concomitant injuries, mechanism of injury, and time to fixation. Operative and clinical notes were evaluated to identify fixation type and outcomes of interest. Patients were stratified into early, standard, and delayed fixation groups (0-3 days, 4-14 days, and >14 days, respectively) for independent analyses, and Fisher's exact test was used to identify differences in complications and reoperations between groups. Multivariate analysis was used to assess associations between patient demographic factors, complication rates, and time to surgery. Results A total of 97 patients met inclusion criteria of having an olecranon open reduction and internal fixation and had a minimum follow-up of at least 10 weeks, with an average follow-up of 7.1 months. The average time to surgery in the overall cohort was 9.3 days. There were no differences in the number of total complications and rate of reoperation among the three cohorts. Smoking was found to be significantly associated with total complications, while open fracture was significantly associated with reoperation. Polytrauma and open fracture were significantly associated with earlier operation, while smoking was significantly associated with delayed fixation. Conclusions The timing of fixation of displaced olecranon fractures does not significantly increase the rate of early complications or reoperation. Type of study/level of evidence Symptom Prevalence Study III.
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Affiliation(s)
| | - Eric R. Taleghani
- University of Virginia Department of Orthopaedics, Charlottesville, VA
| | - Baris Yildirim
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH
| | - Wendy Novicoff
- University of Virginia Department of Orthopaedics, Charlottesville, VA
| | - Aaron M. Freilich
- University of Virginia Department of Orthopaedics, Charlottesville, VA
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13
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Calisal E, Uğur L. Olecranon fractures: A biomechanical comparison of three tension band wiring fixation methods on bone models. J Orthop Surg (Hong Kong) 2023; 31:10225536231223109. [PMID: 38115708 DOI: 10.1177/10225536231223109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
PURPOSE This study aimed to compare the biomechanical pull-out strength of the three different tension band wiring (TBW) methods employed to fix transverse olecranon fractures on bone models. METHODS Three different fixation models were created in groups of seven synthetic olecranon fractured bone models. The first technique was fixed the olecranon with the traditional TBW method. The second technique was fixed the olecranon with a large intramedullary screw TBW method. The third technique was fixed the olecranon with the double-screw TBW method. The pull-out force needed for the failure of each specimen under the tensile test device was evaluated, and the results were recorded. RESULTS We found that the lowest average pull out strength was 55.10 N (range: 35.87-65.85 ± 10.17) in the traditional TBW method, the highest pull out strength was 84.28 N (range: 63.67-117 ± 18.87) in the double-screw TBW method. The pull out strength was 70.80 N (range: 52.60-80.95 ± 10.18) in the intramedullary screw TBW method. In terms of ultimate failure loads, there was no significant difference between the intramedullary screw TBW and the double-screw TBW (p > .05) while there was a significant difference between the traditional TBW and the other two methods (p < .05). CONCLUSION The use of screw(s) shows higher biomechanical stability than K-wires in the TBW method. Double-screws fixation gives similar results in terms of the biomechanical load to failure compared to a large intramedullary screw fixation. Both screw methods can be used as stable constructs in clinical practice. LEVEL OF EVIDENCE III, biomechanical trial.
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Affiliation(s)
- Emre Calisal
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Levent Uğur
- Department of Mechanical Engineering, Faculty of Engineering, Amasya University, Amasya, Turkey
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14
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Luenam S, Kosiyatrakul A. Triple suture fixation for displaced comminuted olecranon fracture with a stable ulnohumeral joint. J Orthop Surg (Hong Kong) 2023; 31:10225536231215576. [PMID: 37947353 DOI: 10.1177/10225536231215576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To report the outcome of a novel fixation technique using three high-strength sutures which is including articular buttress suture, cerclage suture, and tension band with off-loading triceps suture (triple suture fixation) in the treatment of displaced comminuted olecranon fracture with a stable ulnohumeral joint (Mayo type IIB). The rationale of using this technique is that the sutures have been used to stabilize multiple fracture fragments in all sides of the olecranon. MATERIAL AND METHODS Between July 2018 and July 2021, 10 patients (7 women, 3 men; mean age, 49.9 years; mean follow-up duration, 27.8 months) with Mayo type IIB olecranon fractures who underwent triple suture fixation were included in the study. The elbow was immobilized in a splint for 2 weeks postoperatively. Range-of-motion exercises were initiated after splint removal and weight bearing was allowed at 6 weeks postoperatively. RESULTS Average active range of motion of the elbow was 145° of flexion (range, 135°-150°), 6.5° of extension (range, 0°-30°), 83° of supination (range, 70°-85°), and 77.5° of pronation (range, 70°-80°). Mean MEPS was 98.3 (range, 85-100) and DASH score was 3.1 (range, 0-10) at the final follow-up. Radiographic data at the final follow-up analyzed by paired t test demonstrated that there was no statistically significant difference of proximal olecranon height (OH), trochlear notch width (TW), and OH/TW ratio between postoperative treatment and normal side (p-value >.05). No complication of implant prominence, fixation failure, nonunion, infection or heterotopic ossification was found postoperatively. Breakage of drill bit occurred during drilling a distal oblique hole for articular buttress suture in one patient. CONCLUSION The triple suture fixation is an effective treatment with low incidence of complications in treatment of Mayo type IIB olecranon fractures. Larger comparative studies are needed to confirm the value of such technique.
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Affiliation(s)
- Suriya Luenam
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Arkaphat Kosiyatrakul
- Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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15
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Cornefjord G, Kostogiannis I, Rogmark C, Jerrhag D, Wenger D. The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial. Trials 2023; 24:559. [PMID: 37641082 PMCID: PMC10464474 DOI: 10.1186/s13063-023-07566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Displaced olecranon fractures with a stable elbow joint are classified as Mayo type 2a or 2b and are commonly operated with tension band wiring, i.e. two K-wires and a cerclage. Retrospective studies have reported fewer reoperations and complications with cerclage fixation alone when compared to tension band wiring, though with similar long-term results. We decided to compare tension band wiring to cerclage fixation of displaced, stable olecranon fractures in adults in a randomized controlled trial. METHODS All patients ≥ 18 years old with Mayo type 2a and 2b fractures presenting at Skåne University hospital will be eligible for study inclusion, unless exclusion criteria are met. Two hundred participants will be included and randomized 1:1 to cerclage fixation or tension band wiring. Outpatient physiotherapist follow-up appointments will be scheduled at 2 and 6 weeks and at 3, 12, and 36 months at the Dept. of Orthopaedics. A lateral view radiograph of the elbow will be analysed at 6 months. The primary outcome of our study is the rate of reoperations. Secondary outcomes are complication rates, severity of complications, and patient-reported outcome measures (QuickDASH, Short Musculoskeletal Function Assessment, pain level, and patient satisfaction). The sample size was calculated to give 80% power for detecting a statistically significant difference in reoperation rates (with alpha-value 0.05), based on a previous retrospective study. DISCUSSION Reoperation and complication rates after tension band wiring of olecranon fractures are high. Treatment of these injuries is debated, and several ongoing trials compare tension band wiring with plate fixation, suture fixation, and non-operative treatment. As data from retrospective studies indicate that cerclage fixation may be superior to tension band wiring, we see a need for a randomized controlled trial comparing these methods. The WOW-OK Trial aims to obtain level-1 evidence that may influence treatment choice for this type of fracture. TRIAL REGISTRATION ClinicalTrials.gov NCT05657899 . Registered on 16 November 2022. The trial complies with SPIRIT and CONSORT guidelines. The SPIRIT figure is found in Table 2.
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Affiliation(s)
- Gustav Cornefjord
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden.
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
| | - Ioannis Kostogiannis
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Rogmark
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Daniel Jerrhag
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
| | - Daniel Wenger
- Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
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16
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Dogramatzis K, Kitridis D, Bekoulis T, Craig R. Novel suture/suture-anchor fixation versus tension band wiring for olecranon fractures: A systematic review. Shoulder Elbow 2023; 15:424-435. [PMID: 37538526 PMCID: PMC10395410 DOI: 10.1177/17585732221094828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 08/05/2023]
Abstract
Introduction Tension Band Wiring (TBW) has traditionally been the cornerstone of operative management for simple displaced olecranon fractures but its success is limited by high complication rates, mainly related to metalwork irritation and fixation failure. Over the last twelve years, a number of novel fixation methods not involving metalwork have been described in case series (suture fixation, SF and suture-anchor fixation, SAF) with promising early results. In this systematic review, the outcomes of SF and SAF techniques are presented alongside those for TBW for the treatment of closed olecranon fractures without elbow instability. Materials and methods Five databases (Medline, Scholar, Scopus, Prospero and Cochrane) were searched for clinical studies involving TBW/SF/SAF for closed Mayo 1A/1B/2A/2B olecranon fractures from January 2010 onwards. Primary outcomes included overall complication and reoperation rates, as well as the rate of each specific complication. Elbow range of movement, surgeon and patient-reported outcome measures were defined as secondary outcomes. Results Eighteen studies were included, nine of which involved SF/SAF (99 patients) and nine TBW (382 patients). SF/SAF techniques were associated with lower rates of fracture/implant displacement (2% versus 9.7%, p = 0.01), implant irritation (1% versus 30.1%, p < 0.001) and overall complications (8% versus 46.1%, p < 0.001) when compared to TBW. Reoperation rates were lower for SF/SAF (3% versus 37.2%, p < 0.001). Total flexion/extension arc achieved was similar (130.16 ± 2.11 versus 129.45 ± 0.93 degrees). On average, patients regained a functional arc of flexion (135.21 ± 4.81 TBW versus 131.32 ± 12.99 SF/SAF) and extension (1.16 ± 7.54 SF/SAF versus 5.76 ± 7.98 TBW). Conclusion Current evidence suggests that SF/SAF of simple olecranon fractures is a safe and effective alternative to the current gold standard TBW fixation, with preliminary evidence suggestive of lower complication and reoperation rates. Firm conclusions of equivalence or superiority are not possible based on the current poor quality of literature available. Until the outcomes of high-quality prospective studies are available, patients should be carefully counselled that suture methods remain novel and outcomes should be regularly audited.
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Affiliation(s)
| | - Dimitrios Kitridis
- 1st Orthopaedic Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Richard Craig
- University Hospitals Coventry and Warwickshire, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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17
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Xiong X, Chen YL, Zhao L, Li H, Xu M, Shuang F. Individualized 3D-printed navigation template-assisted tension band wiring for olecranon fractures. J Orthop Surg Res 2023; 18:407. [PMID: 37271815 DOI: 10.1186/s13018-023-03892-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 06/06/2023] Open
Abstract
PURPOSE 3D printing techniques guide precision medicine and show great development potential in clinical applications. The purpose of this study was to compare the clinical outcomes of 3D-printed navigation templates versus free-hand in tension band wiring (TBW) procedures for olecranon fractures. METHODS Patients who underwent TBW due to Mayo type II olecranon fractures between January 2019 and December 2021 in our hospital were prospectively enrolled in the study. The patients were divided into the 3D printed navigation template guiding TBW group (3D printed group) and the free-hand TBW group (free-hand group). The primary endpoint of this study was the success rate of the bicortical placement of Kirschner wires (K-wires). Times of intraoperative fluoroscopy, operation times, complications, VAS scores, and Mayo Elbow Performance Scores (MEPS) were analyzed as the secondary outcomes measure. RESULTS The success rate of the bicortical placement of K-wires was 85.7% in the 3D Printed group was significantly higher than the free-hand group (60%). There were fewer times of intraoperative fluoroscopy in the 3D Printed group (1.43 ± 0.51) than that in the free-hand group (2.60 ± 1.00) with statistical significance (P < 0.05). At the date of the last follow-up, four patients suffer from pain and skin injury at the K-wires insertion site in the 3D Printed group and 14 patients in the free-hand group, a significant difference between the two groups (P < 0.05). No statistically significant differences were found in operation time, VAS scores, and MEPS between the two groups. CONCLUSIONS The individualized 3D-printed navigation template-assisted TBW demonstrated good accuracy and resulted in reduced times of intraoperative fluoroscopy and complication compared to the free-hand TBW for olecranon fractures.
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Affiliation(s)
- Xu Xiong
- Department of Orthopedic Surgery, The 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, No.1028 Jinggangshan Avenue, Qingyunpu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
- The First Clinical Medical College of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Ya-Ling Chen
- Department of Neurology and Orthopedic Intensive Care Unit, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Lan Zhao
- Department of Orthopedic Surgery, The 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, No.1028 Jinggangshan Avenue, Qingyunpu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Hao Li
- Department of Orthopedic Surgery, The 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, No.1028 Jinggangshan Avenue, Qingyunpu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Min Xu
- Department of Orthopedic Surgery, The 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, No.1028 Jinggangshan Avenue, Qingyunpu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Feng Shuang
- Department of Orthopedic Surgery, The 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, No.1028 Jinggangshan Avenue, Qingyunpu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
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18
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Duckworth AD, Carter TH, Chen MJ, Gardner MJ, Watts AC. Olecranon fractures : current treatment concepts. Bone Joint J 2023; 105-B:112-123. [PMID: 36722062 DOI: 10.1302/0301-620x.105b2.bjj-2022-0703.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite being one of the most common injuries around the elbow, the optimal treatment of olecranon fractures is far from established and stimulates debate among both general orthopaedic trauma surgeons and upper limb specialists. It is almost universally accepted that stable non-displaced fractures can be safely treated nonoperatively with minimal specialist input. Internal fixation is recommended for the vast majority of displaced fractures, with a range of techniques and implants to choose from. However, there is concern regarding the complication rates, largely related to symptomatic metalwork resulting in high rates of implant removal. As the number of elderly patients sustaining these injuries increases, we are becoming more aware of the issues associated with fixation in osteoporotic bone and the often fragile soft-tissue envelope in this group. Given this, there is evidence to support an increasing role for nonoperative management in this high-risk demographic group, even in those presenting with displaced and/or multifragmentary fracture patterns. This review summarizes the available literature to date, focusing predominantly on the management techniques and available implants for stable fractures of the olecranon. It also offers some insights into the potential avenues for future research, in the hope of addressing some of the pertinent questions that remain unanswered.Cite this article: Bone Joint J 2023;105-B(2):112-123.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wrightington, UK
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19
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Deemer AR, Perskin CR, Littlefield CP, Drake J, Ganta A, Konda S, Egol KA. Fractures of the Proximal Ulna: A Spectrum of Injuries and Outcomes. Indian J Orthop 2023; 57:262-268. [PMID: 36777131 PMCID: PMC9880104 DOI: 10.1007/s43465-022-00793-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Introduction The purpose of this study is to assess the effect of radial head/ neck injury in association with proximal ulna fractures. Methods Between 2006 and 2020, 107 patients presented to our academic medical center for treatment of a proximal ulna fracture and were enrolled into an IRB-approved database. Radiographs, injury details, and surgical interventions were retrospectively reviewed. Patients were classified as having an isolated proximal ulna fracture (PU), a PU fracture with an associated radial head dislocation (M-D), or a Monteggia fracture with an associated radial head fracture (M-V). Clinical and functional outcomes were assessed at follow-up to determine what differences exist between fracture patterns. Statistics were generated using Chi-squared tests for categorical variables and one-way ANOVA tests for numerical variables. Results While all patients ultimately healed, time to radiographic healing in the PU cohort was shorter at 3.57 ± 1.7 months when compared to the M-V cohort (5.67 ± 3.8 months) (p < 0.05). At follow-up, patients in the M-V cohort had poorer elbow pronation and supination when compared to the PU and M-D cohorts (p < 0.05). Patients within the PU cohort had fewer complications than those in the M-D and M-V cohorts (p < 0.05). No differences were found between the three cohorts in regard to rates of reoperation, non-union, wound infection, and nerve compression (p > 0.05). Conclusion The Monteggia fracture with a concomitant radial head/neck fracture is a more disabling injury pattern when compared to an isolated proximal ulna fracture and Monteggia fracture without an associated radial head/neck fracture.
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Affiliation(s)
- Alexa R. Deemer
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Cody R. Perskin
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Connor P. Littlefield
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Jack Drake
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
| | - Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
| | - Sanjit Konda
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
| | - Kenneth A. Egol
- Department of Orthopedic Surgery, NYU Langone Medical Center, NYU Langone Orthopedic Hospital, NYU Langone Health, 301 E 17th Street, New York, NY 10003 USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY USA
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20
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Qi H, Li Z, Ma T, Du B, Ren C, Xu Y, Huang Q, Zhang K, Lu Y, Li M. A novel internal fixation technique for the treatment of olecranon avulsion fracture. Front Surg 2023; 9:1019767. [PMID: 36726952 PMCID: PMC9886313 DOI: 10.3389/fsurg.2022.1019767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023] Open
Abstract
Objective Tension band wiring and proximal ulnar plate fixation are commonly used fixation methods for olecranon fractures. However, they may not be suitable for repairing proximal olecranon avulsion fractures. In this study, we present a novel fixation technique for the treatment of proximal avulsion fractures, which is a T-shaped plate combined with a wire. Materials and methods Between March 2016 and May 2020, surgery was performed on 16 patients with proximal olecranon avulsion fractures by using a T-shaped plate combined with a wire fixation at our hospital. The parameters followed were fracture healing time, elbow range of motion (ROM), related functional scores (the Mayo score and the DASH score), and complications related to internal fixation. Results The average follow-up period was 17 (14-21) months and fractures had healed in all patients included in the study, with an average fracture union of 9.25 (8-12) weeks. No patient reported fixation failure, serious infection, or revision surgery. The average ROM of the elbow joint was 123° (120-135°). The Mayo score was excellent in 11 patients and good in 5. The average DASH score was 17.75 (12-24). Conclusion Olecranon avulsion fractures were fixed with a T-shaped steel plate combined with a steel wire, which can be used for early functional exercise and for achieving good final functional results. This method can provide stable fixation, especially in elderly patients with osteoporosis.
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Affiliation(s)
| | | | - Teng Ma
- Correspondence: Ming Li Teng Ma
| | | | | | | | | | | | | | - Ming Li
- Correspondence: Ming Li Teng Ma
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21
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Cook E, James S, Watts AC. A randomized controlled trial to compare clinical and cost-effectiveness of suture fixation versus tension band wiring for simple olecranon fracture fixation in adults: The Simple Olecranon Fracture Fixation Trial (SOFFT) protocol. Bone Jt Open 2023; 4:27-37. [PMID: 36641631 PMCID: PMC9887338 DOI: 10.1302/2633-1462.41.bjo-2022-0132.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS Olecranon fractures are usually caused by falling directly on to the olecranon or following a fall on to an outstretched arm. Displaced fractures of the olecranon with a stable ulnohumeral joint are commonly managed by open reduction and internal fixation. The current predominant method of management of simple displaced fractures with ulnohumeral stability (Mayo grade IIA) in the UK and internationally is a low-cost technique using tension band wiring. Suture or suture anchor techniques have been described with the aim of reducing the hardware related complications and reoperation. An all-suture technique has been developed to fix the fracture using strong synthetic sutures alone. The aim of this trial is to investigate the clinical and cost-effectiveness of tension suture repair versus traditional tension band wiring for the surgical fixation of Mayo grade IIA fractures of the olecranon. METHODS SOFFT is a multicentre, pragmatic, two-arm parallel-group, non-inferiority, randomized controlled trial. Participants will be assigned 1:1 to receive either tension suture fixation or tension band wiring. 280 adult participants will be recruited. The primary outcome will be the Disabilities of the Arm, Shoulder and Hand (DASH) score at four months post-randomization. Secondary outcome measures include DASH (at 12, 18, and 24 months), pain, Net Promotor Score (patient satisfaction), EuroQol five-dimension five-level score (EQ-5D-5L), radiological union, complications, elbow range of motion, and re-operations related to the injury or to remove metalwork. An economic evaluation will assess the cost-effectiveness of treatments. DISCUSSION There is currently no high-quality evidence comparing the clinical and cost effectiveness of the tension suture repair to the traditional tension band wiring currently offered for the internal fixation of displaced fractures of the olecranon. The Simple Olecranon Fracture Fixation Trial (SOFFT) is a randomized controlled trial with sufficient power and design rigour to provide this evidence for the subtype of Mayo grade IIA fractures.Cite this article: Bone Jt Open 2023;4(1):27-37.
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Affiliation(s)
- Elizabeth Cook
- York Trials Unit, Department of Health Sciences, University of York, York, UK,Correspondence should be sent to Elizabeth Cook. E-mail:
| | - Sophie James
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Adam C. Watts
- Wrightington, Wigan & Leigh Teaching Hospitals NHS Foundation Trust, Wigan, Lancashire, UK
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22
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Folberg CR, Alves JADO, Pereira FMS, Rabuske WBS. Wide-Awake Olecranon Fracture Fixation: Is it Possible? JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:201-205. [PMID: 36974301 PMCID: PMC10039312 DOI: 10.1016/j.jhsg.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose The wide-awake local anesthesia no tourniquet technique has been widely performed in hand and wrist surgery with remarkable results. However, its use on the elbow has rarely been reported. Here we describe the use of wide-awake local anesthesia no tourniquet in olecranon fracture fixation in 4 cases. Methods Tumescent anesthesia was injected from the proximal ulna to approximately 10 cm distally and into the periosteum and fracture site, approximately 25 minutes before skin incision. The fracture underwent closed reduction and was fixed using a long 6.5-mm cancellous screw with a washer through a small incision. No tourniquet was applied and none or mild sedation was administered. At the end of the operation, patients were asked to perform active elbow flexion-extension and forearm pronosupination movements under an image intensifier to test the range of motion and fracture stability. Results The surgical procedure was completed in all 4 cases. Two patients reported mild pain during ulnar medullary canal reaming, with pain scores of 3 and 4 on a 10-point scale, respectively. One case was resolved with additional local anesthetic injection. The other case required the administration of intravenous propofol. Both patients were able to actively move the elbow at the end of the operation. Conclusions The use of wide-awake local anesthesia no tourniquet for olecranon fracture fixation has the advantage of obviating the need for an arm tourniquet, general anesthesia or heavy sedation, preoperative tests, and discontinuing routine medications (including anticoagulants). The stability of the elbow fixation was tested by active motion during surgery. This simple, safe, low-cost, and reproducible technique may be a good option for patients with contraindications or high risk of general or regional nerve block anesthesia. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Celso Ricardo Folberg
- Department of Orthopedics, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
- Corresponding author: Celso Ricardo Folberg, MD, MSc, Department of Orthopedics, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil.
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23
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Hamoodi Z, Duckworth AD, Watts AC. Olecranon Fractures: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202301000-00009. [PMID: 36638218 DOI: 10.2106/jbjs.rvw.22.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
» Olecranon fractures account for 10% of all elbow fractures and are more likely to result from a low-energy injury. A displaced fracture with a stable ulnohumeral joint (Mayo type 2) is the most common type of injury. » The management of an isolated olecranon fracture is based on patient factors (age, functional demand, and if medically fit to undergo surgery) and fracture characteristics including displacement, fragmentation, and elbow stability. » Nonoperative management can be successfully used in undisplaced fractures (Mayo type 1) and in displaced fractures (Mayo type 2) in frail patients with lower functional demands. » Patients with displaced olecranon fractures with a stable ulnohumeral joint without significant articular surface fragmentation (Mayo type 2A) can be managed with tension band wiring, plate osteosynthesis (PO), intramedullary fixation, or suture repair. » PO is advocated for multifragmentary fractures and fractures that are associated with ulnohumeral instability. It is essential to consider the variable anatomy of the proximal ulna during surgery.
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Affiliation(s)
- Zaid Hamoodi
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
| | - Andrew D Duckworth
- Edinburgh Orthopaedic Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wigan, United Kingdom
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24
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Schmoelz W, Zierleyn JP, Hoermann R, Arora R. Standardized fracture creation in the distal humerus and the olecranon for surgical training and biomechanical testing. Arch Orthop Trauma Surg 2022; 142:3853-3861. [PMID: 34973090 PMCID: PMC9596540 DOI: 10.1007/s00402-021-04286-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/27/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Surgical training and biomechanical testing require models that realistically represent the in vivo injury condition. The aim of this work was to develop and test a method for the generation of distal humerus fractures and olecranon fractures in human specimens, while preserving the soft tissue envelope. METHODS Twenty-one cadaveric upper extremity specimens (7 female, 14 male) were used. Two different experimental setups were developed, one to generate distal humerus fractures and one to generate olecranon fractures. Specimens were placed in a material testing machine and fractured with a predefined displacement. The force required for fracturing and the corresponding displacement were recorded and the induced energy was derived of the force-displacement graphs. After fracturing, CT imaging was performed and fractures were classified according to the AO classification. RESULTS Eleven distal humerus fractures and 10 olecranon fractures with intact soft tissue envelope could be created. Distal humerus fractures were classified as AO type C (n = 9) and as type B (n = 2), all olecranon fractures were classified as AO type B (n = 10). Distal humerus fractures required significantly more load than olecranon fractures (6077 N ± 1583 vs 4136 N ± 2368, p = 0.038) and absorbed more energy until fracture than olecranon fractures (17.8 J ± 9.1 vs 11.7 J ± 7.6, p = 0.11), while the displacement at fracture was similar (5.8 mm ± 1.6 vs 5.9 mm ± 3.1, p = 0.89). CONCLUSION The experimental setups are suitable for generating olecranon fractures and distal humerus fractures with intact soft tissue mantle for surgical training and biomechanical testing.
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Affiliation(s)
- Werner Schmoelz
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Jan Philipp Zierleyn
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Romed Hoermann
- Division Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Rohit Arora
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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25
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Welch JM, Zhuang T, Shapiro LM, Gardner MJ, Xiao M, Kamal RN. Cost minimization analysis of the treatment of olecranon fracture in elderly patients: a retrospective analysis. CURRENT ORTHOPAEDIC PRACTICE 2022; 33:559-564. [PMID: 36873608 PMCID: PMC9977169 DOI: 10.1097/bco.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients. Methods Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payer perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications. Results One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs US$2,544). 31.05% of operative cases were associated with a significant complication compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs $2,320). Conclusions These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payers shift toward value-based reimbursement models in which quality of care and cost influence surgical decision making. Level of Evidence Level IV.
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Affiliation(s)
- Jessica M. Welch
- VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA
| | - Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
| | - Michael J Gardner
- VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA
| | - Michelle Xiao
- VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA
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26
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Bouchard C, Bornes TD, Silveira A, Hemstock R, Beaupre L, Chan R. Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study. J Shoulder Elbow Surg 2022; 31:e418-e425. [PMID: 35568260 DOI: 10.1016/j.jse.2022.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several fixation techniques have been described to treat acute olecranon fractures. Plate fixation is often used because of its superior mechanical properties. The reported rates of reoperation after olecranon plate fixation have been quite heterogeneous. The purpose of this study was to establish an updated reoperation rate based on modern precontoured plate constructs. METHODS This retrospective cohort study used population-level administrative data to identify all surgically treated adult patients with olecranon fractures at 4 hospitals in Edmonton, AB, Canada, between 2010 and 2015. Radiographic review was conducted to identify patients who underwent precontoured olecranon plate fixation. Fracture characteristics including Mayo fracture classification and other concomitant upper-extremity injuries were identified. Chart reviews were performed to determine patient characteristics and patients who required reoperation. The primary reason for and type of reoperation were determined. RESULTS Six hundred patients were surgically treated for olecranon fractures. Precontoured plate fixation was used in 321 patients. The average age of included patients was 56 years (standard deviation [SD], 19.4 years), and there were 173 female patients (53.9%). Reoperation was required in 90 patients (28%). For 50 patients, implant-related irritation was the primary reason for reoperation, representing 55.6% of the patients who underwent reoperation (50 of 90) and 15.6% of the total cohort (50 of 321). Other reasons for reoperation included hardware failure in 17 patients (5.3%), infection in 9 (2.8%), and contracture in 9 (2.8%). Patients who required reoperation were significantly younger (52.9 years [SD, 18.1 years] vs. 57.7 years [SD, 19.4 years]; P = .048) and had significantly higher rates of type III olecranon fractures (17.8% [16 of 90] vs. 8.2% [19 of 231]; P = .04) and Monteggia fractures (13.3% [12 of 90] vs. 4.8% [11 of 231]; P = .008). A multivariate logistic regression model also demonstrated increased odds ratios (ORs) for overall reoperation in patients with Monteggia fractures (OR, 2.99 [95% confidence interval, 1.25-7.17]; P = .014) and for reoperation due to implant-related irritation in younger patients (OR, 0.98 [95% confidence interval, 0.96-0.996]; P = .018). No discerning factors were identified for the 50 patients who underwent hardware removal for implant-related irritation compared with the whole reoperation group (n = 90). CONCLUSION This study found that patients with olecranon fractures treated with precontoured plates experienced a hardware removal rate of 15.6% for implant-related irritation. Patients who sustained more complex fractures, such as Monteggia injuries, demonstrated higher rates of reoperation. Increasing age may be associated with lower rates of reoperation. In patients who required reoperation, there were no identifiable radiographic or clinical characteristics that were associated with implant-related irritation as their primary reason for reoperation.
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Affiliation(s)
- Charles Bouchard
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Troy D Bornes
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Anelise Silveira
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Western Upper Limb Facility, Sturgeon Hospital, St. Albert, AB, Canada; Collaborative Orthopaedic Research, University of Alberta, Edmonton, AB, Canada
| | - Riley Hemstock
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lauren Beaupre
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Collaborative Orthopaedic Research, University of Alberta, Edmonton, AB, Canada; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert Chan
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; Western Upper Limb Facility, Sturgeon Hospital, St. Albert, AB, Canada.
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27
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Jia Y, Liu A, Guo T, Chen J, Yu W, Zhai J. Efficacy and safety of tension band wire versus plate for Mayo II olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:373. [PMID: 35922818 PMCID: PMC9351198 DOI: 10.1186/s13018-022-03262-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/24/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose For olecranon fractures, the choice of tension band wire (TBW) or plate fixation has long been controversial. Therefore, this study aimed to evaluate the efficacy and safety of TBW and plate in the treatment of patients with Mayo II olecranon fractures by Meta-analysis.
Methods PubMed, Embase, Cochrane, the Web of Science, China National Knowledge Infrastructure, Wanfang, and China Biomedical Database were searched for randomized controlled trials (RCTs) and cohort studies (CSs) where TBW was compared with plate for Mayo II olecranon fractures (OF). Subsequently, the data were extracted by two reviewers independently and were analysed via RevMan5.4.1. Besides, mean difference (MD), risk ratio (RR), and 95% confidence intervals (CIs) were calculated. Furthermore, Cochrane Risk of Bias Tool 2.0 and Newcastle–Ottawa Scale were adopted for assessing the risk of bias. Results A total of 1RCT and 10 CSs were included, when 449 cases were treated with TBW and 378 with plate. The plate has favourable postoperative long-term (≥ 1 year) functional score in MEPS (MD: − 3.06; 95% CI − 5.50 to 0.62; P = 0.01; I2 = 41%) and Dash score (MD: 2.32; 95% CI 1.91, 2.73; P < 0.00001; I2 = 0%), also carrying fewer complications (RR: 2.13; 95% CI 1.48, 3.08; P < 0.0001; I2 = 58%). Besides, there exists no significant difference in postoperative long-term (≥ 1 year) elbow flexion (MD: − 1.82°; 95% CI − 8.54, 4.90; P = 0.60; I2 = 71%) and extension deficits (MD: 1.52°; 95% CI − 0.38, 3.42; P = 0.12; I2 = 92%). Moreover, TBW is featured with a shorter operation time (MD = − 5.87 min; 95% CI − 7.93, − 3.82; P < 0.00001; I2 = 0) and less intraoperative bleeding (MD: − 5.33 ml; 95% CI − 8.15, − 2.52; P = 0.0002; I2 = 0). In terms of fracture healing time, it is still controversial. Furthermore, the subgroup analysis has revealed that for Mayo IIA OF, the plate has a better outcome in the long-term (≥ 1 year) postoperative MEPS, the Dash score, and the incidence of postoperative complications than TBW, while there is no significant difference in the long-term (≥ 1 year) postoperative elbow motion between two groups. Conclusions Plate has better efficacy and safety for Mayo II OF. Considering that few studies are included in the meta-analysis, more high-quality RCTs are still required to confirm these findings. PROSPERO registration number: CRD42022313855. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03262-7.
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Affiliation(s)
- Yizhen Jia
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Aifeng Liu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China. .,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
| | - Tianci Guo
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jixin Chen
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weijie Yu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jingbo Zhai
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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Sobel AD, Babu JM, Blood TD, Paxton ES. Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model. J Hand Surg Am 2022; 47:796.e1-796.e6. [PMID: 35031124 DOI: 10.1016/j.jhsa.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes. A biomechanical comparison of DLP and PLP fixation would help to validate the use of DLPs in comminuted olecranon fractures. METHODS Seven matched pairs of cadaveric upper extremities were evaluated with quantitative computed tomography scans to evaluate bone mineral density (BMD). Osteotomies simulating comminuted olecranon fractures (Mayo Type IIB) were created and the specimens were fixed either with variable angle PLPs or variable angle DLPs. The specimens were then cyclically loaded and loaded to failure. The ultimate strength, fracture displacement, and mechanism of failure were recorded and compared across groups. The correlation between BMD and ultimate strength was analyzed. RESULTS The mean total BMD was 0.79 g/cm2 (SD, 0.14 g/cm2). No specimen failed during cyclic testing. Five of 7 PLP specimens and 5 of 7 DLP specimens failed by fracture through the proximal screws though in different planes (sagittal vs axial splits, respectively). The mean ultimate strengths of the PLP (1077 N [SD, 462 N]) and DLP (1241 N [SD, 506 N]) groups were similar. There was a linear relationship between ultimate strength and BMD (R2 = 0.33). CONCLUSION Dual locking plates display biomechanical properties that suggest that they can be used in the fixation of comminuted olecranon fractures. Catastrophic failure of the fixation constructs occurs around stress risers at the proximal screws rather than due to displacement at the fracture itself. CLINICAL RELEVANCE Dual locking plate constructs can be considered for use in the fixation of comminuted olecranon fractures.
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Affiliation(s)
- Andrew D Sobel
- Department of Orthopaedics, St. Luke's University Health Network, Bethlehem, PA; Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Jacob M Babu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Travis D Blood
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - E Scott Paxton
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
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29
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Alvara CA, Biedron G, Dunn JC. Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review. Hand (N Y) 2022; 17:734-739. [PMID: 35815367 PMCID: PMC9274873 DOI: 10.1177/1558944720944261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population. METHODS A literature search of the PubMed database was performed using the term olecranon fracture. Papers included those with results for patients aged 65 years and older published between 1990 and 2018 in the English language. Data were pooled to analyze outcomes and complications of nonoperative management of olecranon fractures in the elderly patient population. RESULTS Four eligible studies combined for a total of 69 patients with 70 fractures with an average age of 83.8 years (71-95 years), female predominance of 88%, and a mean follow-up of 12.4 months who underwent nonoperative management of displaced olecranon fractures. While only 25% of fractures went on to radiographic union, the mean Disabilities of the Arm, Shoulder, and Hand score was 16.9 (0-59.6), the mean arc of motion was 138°, and 92% of patients achieved excellent results. One-quarter (26%) of the patients experienced complications: radial head subluxation (1), skin sore (1), degenerative arthropathy (1), pain on movement (2), click in movement of the elbow (5), and local pain (8). CONCLUSION Displaced olecranon fractures in patients aged older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion.
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Affiliation(s)
- Christina A. Alvara
- Texas Tech University Health Sciences Center El Paso, USA,Christina A. Alvara, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, 5001 El Paso Drive, El Paso, TX 79905, USA.
| | - Griffin Biedron
- Texas Tech University Health Sciences Center El Paso, USA,William Beaumont Army Medical Center, El Paso, TX, USA
| | - John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
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30
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Tian Y, Ge X, Zou J, Song F, Cheong JCTCW, Ge C, Zhang W, Li J, Tian K. Case Report: J-Shaped External Fixator for Treatment of Mayo Type II Olecranon Fractures – A Novel Surgical Technique and Report of Clinical Applications. Front Surg 2022; 9:855600. [PMID: 35784935 PMCID: PMC9240390 DOI: 10.3389/fsurg.2022.855600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose We designed a J-shaped external fixator (J-EF) to provide a minimally invasive, one-step surgical method for olecranon fractures. The aim of this study is to retrospectively review the method and the outcomes in 14 patients treated with J-EF fixation. Methods Biomechanical comparative study was performed to test the tensile properties of the J-EF using a universal testing machine. Between January 2002 and December 2005, 14 patients (age range: 25–67 years) with Mayo type II olecranon fractures were treated using the external fixation technique. Follow-up was done by standard measures (radiography, range of motion, and complications monitoring) and patient-reported outcomes (Mayo Elbow Performance Score [MEPS] and Disabilities of the Arm, Shoulder, and Hand [DASH] scores) 6 months after surgery. Eight of the patients were reviewed 15 years after the surgery. Results Results from biomechanical studies indicate the non-inferiority of J-EF to tension-band wiring (TBW) in tensile properties. At the time of release, the mean elbow flexion arc was 132.5° and the mean forearm rotation arc was 173.6°. The mean DASH score was 14.1 points, and the mean MEPS was 93.9 points. Operative time and intraoperative blood loss were decreased by 41.3% and 64.6%, respectively, in J-EF patients than those in a comparable group treated by TBW. All eight patients are still alive after the surgery and maintaining the original outcome. Conclusions External fixation using the J-EF could be considered as an alternative treatment for Mayo type II olecranon fractures as it appears to be a reliable, minimally invasive, and time-saving. Level of Evidence Therapeutic Level IV.
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Affiliation(s)
- Yue Tian
- Department of Orthopedics, No. 2 Hospital of Baoding, Chengde Medical University, Baoding, China
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Xin Ge
- Department of Orthopedics, No. 2 Hospital of Baoding, Chengde Medical University, Baoding, China
- EmergencyCenter, First Central Hospital of Baoding, Baoding, China
| | - Jiyang Zou
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Fenglei Song
- Department of Orthopedics, No. 2 Hospital of Baoding, Chengde Medical University, Baoding, China
| | | | - Changqing Ge
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Weiguo Zhang
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jie Li
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Kang Tian
- Department of Orthopedics, No. 2 Hospital of Baoding, Chengde Medical University, Baoding, China
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
- Correspondence: Kang Tian
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Qi H, Li Z, Lu Y, Ma T, Ji S, Du B, Li M, Huang Q, Zhang K, Yang Y. Comparison of clinical outcomes of three internal fixation techniques in the treatment of olecranon fracture: a retrospective clinical study. BMC Musculoskelet Disord 2022; 23:521. [PMID: 35650582 PMCID: PMC9158155 DOI: 10.1186/s12891-022-05482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The application of double plating in olecranon fractures is becoming increasingly widespread. There is no research comparing this technique with traditional tension band wiring (TBW) and the single plate technique. The purpose of this study was to compare the efficacy of three fixation techniques in olecranon fractures. MATERIALS AND METHODS From March 2016 to May 2020, we collected the clinical data of 95 patients with olecranon fractures who underwent surgical treatment. Thirty-five patients received TBW surgery (TBW Group), 32 patients received a 3.5 mm locking compression plate (LCP, 3.5 mm LCP Group), and 28 patients received double mini-locking plate treatment (DP Group). The operation time, fracture union time, time of return to work, range of motion (ROM), soft tissue stimulation to remove internal fixation, and patient-related functional results (the Weseley score, Mayo Elbow Performance Score [MEPS], and Disabilities of Arm, Shoulder and Hand Score [DASH]) were recorded. The clinical results and complications of the three internal fixation techniques were compared. RESULTS The average follow-up time was 15.011.82 months (12-18 months). All patients' fractures healed by first intention. There were no statistically significant differences in the operation time, fracture union time, ROM, Weseley score, MEPS or DASH scores of the three groups of patients. The postoperative return time for patients in the TBW group was 10.002.15 weeks, the 3.5 mm LCP group was 9.561.93 weeks, and the DP group was 8.432.38 weeks (P = 0.014); 12 patients in the TBW group required removal of plant due to soft tissue stimulation, the 3.5 mm LCP group had 8 cases, and the DP group had 2 cases (P = 0.038). CONCLUSION The postoperative clinical results and elbow joint function of patients with olecranon fractures fixed by tension band wiring, 3.5 mm LCP and double mini-locking plate are similar, which indicates that double-plate technology can be used as an alternative to the two groups of traditional techniques. In addition, double-plate technology also helps patients return to work earlier and has a lower incidence of soft tissue stimulation.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China.
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China.
| | - Shuai Ji
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
| | - Bing Du
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yanling Yang
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
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The Evolution of Olecranon Fractures and Its Fixation Strategies. Indian J Orthop 2022; 56:1385-1393. [PMID: 35928655 PMCID: PMC9283595 DOI: 10.1007/s43465-022-00646-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Olecranon fractures are a common fracture of the upper extremity. The primary aim was to investigate the evolution of olecranon fractures and fixation method over a period of 12 years. The secondary aim was to compare complication rates of Tension Band Wiring (TBW) and Plate Fixation (PF). MATERIALS AND METHODS Retrospective Study for all patients with surgically treated olecranon fractures from 1 January 2005 to 31 December 2016 from a tertiary trauma center. Records review for demographic, injury characteristics, radiographic classification and configuration, implant choices and complications. Results grouped into three 4-year intervals, analyzed comparatively to establish significant trends over 12 years. RESULTS 262 patients were identified. Demographically, increasing mean age (48.7 to 58.9 years old, p value 0.004) and higher ASA scores (7.1% ASA 3 to 21.0% ASA 3 p value 0.001). Later fractures were more oblique (fracture angle 86.1-100.0 degrees, p value 0.001) and comminuted (Schatzker D type 10.4-30.0%, p value 0.025, single fracture line 94.0-66.0%, p value 0.001). Implant choice, sharp increase in PF compared to TBW (PF 16.0% to PF 80.2%, p value 0.001). Complication-wise, TBW had higher rates of symptomatic implant, implant and bony failures and implant removal. CONCLUSION Demographic and fracture characteristic trends suggest that olecranon fractures are exhibiting fragility fracture characteristics (older age, higher ASA scores, more unstable, oblique and comminuted olecranon fractures). Having a high index of suspicion would alert surgeons to consider use of advanced imaging, utilize appropriate fixation techniques and manage the underlying osteoporosis for secondary fracture prevention. Despite this, trends suggest a potential overutilization of PF particularly for stable fracture patterns and the necessary precaution should be exercised.
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Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy. Tech Hand Up Extrem Surg 2022; 26:250-256. [PMID: 35698310 DOI: 10.1097/bth.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.
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Steadman JN, Stephens AR, Zhang C, Presson AP, Kazmers NH. Cost Assessment of Plating Versus Tension Band Wiring Constructs for Treating Mayo Type 2A Olecranon Fractures. J Hand Surg Am 2022; 47:311-319. [PMID: 35131112 PMCID: PMC8995360 DOI: 10.1016/j.jhsa.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/30/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Tension band wiring (TBW) or plating may be used for fixation with similar clinical outcomes for adults with displaced Mayo 2A olecranon fractures. The primary hypothesis is that total direct costs (TDCs) for surgery are lower for TBW than plating. Our secondary hypothesis is that combined surgical TDCs are lower for TBW even with a 100% rate of subsequent tension band hardware removal and a 0% rate of plate removal. METHODS Patients who underwent TBW or plating of an isolated unilateral Mayo 2A olecranon fracture between July 2011 and January 2020 at a single academic medical center were identified. Then, TDC for each surgery on plate fixation, TBW, and hardware removal was obtained and converted to 2020 US dollars using information technology cost tools provided by our institution. Finally, relative TDCs were compared between plate fixation and TBW groups using univariate and multivariable generalized estimating equations with log-link. RESULTS Of the 97 included patients, the mean age was 50 ± 21 years, and 48% were female. Tension band wiring and plate fixation were performed on 18% (17/97) and 82% (80/97) of male and female patients, respectively. Demographics were similar between groups, although the finding that plate fixation cost 2.6 times that of TBW within the index surgery was significant in the multivariable model, independent of potential confounders (coefficient 2.55, 95% confidence interval: 2.09-3.10). Additionally, mean TDC remained significantly greater for plate fixation even under the hypothetical situation where 100% TBW were removed, and the plate removal rate was 0% (cost difference 181%). CONCLUSIONS Using TBW relative to plate fixation may improve the cost of care for operative Mayo 2A olecranon fractures. Furthermore, this finding was robust to the rate of hardware removal. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analyses III.
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Affiliation(s)
- Jesse N. Steadman
- University of Utah, School of Medicine, 30N 1900E, Salt Lake City, UT, USA 84132
| | - Andrew R. Stephens
- University of Utah, School of Medicine, 30N 1900E, Salt Lake City, UT, USA 84132
| | - Chong Zhang
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT, USA 84108
| | - Angela P. Presson
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT, USA 84108
| | - Nikolas H. Kazmers
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT, USA 84108,Corresponding Author: Nikolas H. Kazmers, MD MSE, 590 Wakara Way, Salt Lake City, UT, USA 84108, , Phone: 248-895-0568
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Parkes J, Limb R, Quadri ST, Lamb JN, Mohrir G, Yousef A, West RM, Cowling P. Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre. Shoulder Elbow 2022; 14:200-210. [PMID: 35265187 PMCID: PMC8899326 DOI: 10.1177/1758573221994860] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Olecranon fractures in the elderly have an increasing incidence. This retrospective study aims to identify the complications and survivorship of these patients. METHODS All patients >70 years old treated for an olecranon fracture at our institution were identified between 2007 and 2019. Loss of reduction and/or metalwork loosening was recorded. Also noted were wound healing problems, deep/superficial infections, and any subsequent treatment including return to surgery and/or removal of metalwork. RESULTS From a total of 177 cases, 28 presented with concomitant fractures (16%), half of which were hip fractures. The largest treatment group underwent tension band wiring (n = 82, 46%, mean age 80.8 yrs). Twenty-one of these suffered failure of fixation (26%), all requiring return to surgery. The second largest treatment group underwent plating (n = 50 28%, mean age 80.1 yrs). Four of these suffered failure of fixation (8%), all requiring return to surgery. Forty-four patients were treated non-operatively (25%, mean age 83.8 yrs). Two patients suffered other complications (4.5%). Overall 1 year survivorship was 0.82. DISCUSSION Olecranon fractures in the elderly have higher than expected 1 year mortality rates. Operative management results in high complication rates, often requiring return to surgery for metalwork problems. Significant consideration of treatment options is required in this cohort.
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Affiliation(s)
- J Parkes
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - R Limb
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - ST Quadri
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - JN Lamb
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK,School of Medicine, Worsley Building University of Leeds, Leeds, UK
| | - G Mohrir
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - A Yousef
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - RM West
- School of Medicine, Worsley Building University of Leeds, Leeds, UK
| | - P Cowling
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK,School of Medicine, Worsley Building University of Leeds, Leeds, UK,P Cowling, Chapel Allerton Hospital, Leeds, UK.
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Wegmann S, Rausch V, Hackl M, Leschinger T, Scaal M, Müller LP, Wegmann K. Anatomic evaluation of the triceps tendon insertion at the proximal olecranon regarding placement of fracture fixation devices. Surg Radiol Anat 2022; 44:627-634. [PMID: 35301578 PMCID: PMC8960582 DOI: 10.1007/s00276-022-02921-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Olecranon fractures, especially with a small proximal fragment, remain a surgical challenge. Soft tissue irritation and affection of the triceps muscle bear a risk of complications. In order to find an area for a soft-tissue sparing placement of implants in the treatment of olecranon fractures, we aimed to define and measure the segments of the proximal olecranon and evaluate them regarding possible plate placement. METHODS We investigated 82 elbow joints. Ethical approval was obtained from the local ethics committee, After positioning in an arm holder and a posterior approach we described the morphology of the triceps footprint, evaluated and measured the surface area of the triceps and posterior capsule and correlated the results to easily measurable anatomical landmarks. RESULTS We found a bipartite insertional footprint with a superficial tendinous triceps insertion of 218.2 mm2 (± 41.2, range 124.7-343.2), a capsular insertion of 159.3 mm2 (± 30.2, range 99.0-232.1) and a deep, muscular triceps insertion area of 138.1 mm2 (± 30.2, range 79.9-227.5). Olecranon height was 26.7 mm (± 2.3, range 20.5-32.2), and olecranon width was 25.3 mm (± 2.4, range 20.9-30.4). Average correlation between the size of the deep insertion and ulnar (r = 0.314) and radial length (r = 0.298) was obtained. CONCLUSIONS We demonstrated the bipartite morphology of the distal triceps footprint and that the deep muscular triceps insertion area by its measured size could be a possible site for the placement of fracture fixations devices. The size correlates with ulnar and radial length.
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Affiliation(s)
- Sebastian Wegmann
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
- Department for Orthopedic and Trauma Surgery, University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
| | - V Rausch
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - M Hackl
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - T Leschinger
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - M Scaal
- Faculty of Medicine, Department of Anatomy II, University of Cologne, Cologne, Germany
| | - L P Müller
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - K Wegmann
- Center for Orthopedic and Trauma Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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Li Y, Wang K, Sun D, Liu Y, Wang Z, Li A. Short-Term Outcomes of Herbert Screw Fixation for Isolated Olecranon Fractures in Children: A Single-Institution Retrospective Study. Indian J Orthop 2022; 56:1174-1180. [PMID: 35813543 PMCID: PMC9232683 DOI: 10.1007/s43465-022-00609-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
Background The aim of this study was to assess the clinical and radiological outcomes of closed reduction with percutaneous Herbert screw fixation in children with isolated olecranon fractures. Methods We retrospectively reviewed the records of children treated at our center for isolated olecranon fractures (Mayo type IIA) with closed reduction and percutaneous Herbert screw fixation. The related indices and data of the group were collected for comparative analysis after an average follow-up of 6-8 months. The Herbert screws were removed by a second operation. Results Overall, 14 patients with an average age at the time of injury of 11.36 (range 10-14) years were included. All patients had good radiological and clinical outcomes at 6-8 months postoperatively; all had normal elbow ranges of motion and showed complete bone healing on radiographs. There were no foreign body irritation, implant migration, or osteoarthritis cases. Premature epiphyseal closure was noted in six patients. The average QuickDASH score was 1.58. Conclusions Fixation of olecranon fractures with Herbert screws is a safe and easy method in young patients, leading to good functional and radiological results. Nonetheless, determination of the effects of this treatment method on the olecranon ossification center requires long-term follow-up. Graphical abstract
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Affiliation(s)
- Yang Li
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Kelai Wang
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Dong Sun
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Yakun Liu
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Zhe Wang
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
| | - Aiwu Li
- grid.452402.50000 0004 1808 3430Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012 Shandong China
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Wadhwa H, Oquendo YA, Goodnough LH, DeBaun MR, Bishop JA, Gardner MJ. Mini-fragment plating of olecranon fractures is comparable to precontoured small-fragment plating. J Orthop 2022; 30:41-45. [PMID: 35241886 PMCID: PMC8857267 DOI: 10.1016/j.jor.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Though long-term functional outcomes of olecranon fracture plate fixation are favorable, postoperative implant irritation commonly leads to elective removal. We hypothesized that mini-fragment plates will decrease implant removal compared to precontoured plates. METHODS Patients with isolated olecranon fracture (AO/OTA 2U1-B1) treated with plate fixation were retrospectively reviewed. Patients were stratified into groups based on whether they underwent open reduction and internal fixation with a (1) surgeon contoured mini-fragment or (2) precontoured olecranon-specific plate. Rates of symptomatic implants and implant removal were compared. RESULTS 98 and 32 patients were treated with precontoured and mini-fragment plates, respectively. Baseline demographics and comorbidities were similar. Mean follow-up was 20.6 months. There were no differences in rates of postoperative complication (22/98, 22.4% vs. 5/32, 15.6%; p = 0.41) or reoperation (37/98, 37.8% vs. 8/32, 25%; p = 0.19). Symptomatic implants were common in the precontoured cohort (44/98, 44.9% vs. 7/32, 21.9%; p < 0.05). Implant removal rates were 36.7% and 18.8%, respectively (p = 0.06). DISCUSSION/CONCLUSION Olecranon fracture stabilization with mini-fragment plate is associated with lower rates of symptomatic implants, with no difference in postoperative complications or reoperations. Mini-fragment plating is a safe and promising alternative to precontoured plating.
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Affiliation(s)
| | | | | | | | | | - Michael J. Gardner
- Corresponding author. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St., Pavilion C, 4th Floor Redwood City, CA, 94063, USA
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Rantalaiho I, Laaksonen I, Launonen AP, Luokkala T, Flinkkilä T, Salmela M, Adolfsson L, Olsen B, Isotalo K, Ryösä A, Äärimaa V. Scandinavian Olecranon Research in the Elderly (SCORE): protocol for a non-inferiority, randomised, controlled, multicentre trial comparing operative and conservative treatment of olecranon fractures in the elderly. BMJ Open 2022; 12:e055097. [PMID: 35105643 PMCID: PMC8808415 DOI: 10.1136/bmjopen-2021-055097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The incidence of olecranon fractures is growing in the elderly population. The traditional operative approach is giving way among the elderly to conservative treatment, which seems to provide a comparable functional outcome with a lower complication burden. However, there is still a lack of reliable evidence to support this shift.The objective of this trial is to investigate whether conservative treatment of displaced olecranon fractures in patients aged 75 or older yields comparable results to those of operative treatment in terms of pain and daily function. METHODS AND ANALYSIS Scandinavian Olecranon Research in the Elderly (SCORE) is a randomised, controlled, multicentre, non-inferiority trial. Eligible patients will be randomised to either conservative or operative treatment. The sample size will be 68 patients and allocation done at a 1:1 ratio (34 patients per group). The randomisation is stratified according to the participating hospital and patient's sex. Both groups will receive the same postoperative physiotherapy and pain management. The primary outcome is Disabilities of the Arm, Shoulder and Hand at 1-year follow-up. Secondary outcomes are pain and satisfaction measured on visual analogue scales, Patient Reported Elbow Evaluation, range of motion of the elbow and extension strength of the elbow compared with the unaffected arm. Radiographs will be taken at each follow-up. Primary analysis of the results will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and will be submitted for approval to the Regional Ethics Committees in Linköping, Sweden and Copenhagen, Denmark. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04401462. PROTOCOL VERSION This is the second protocol version dated on 16 April 2020.
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Affiliation(s)
- Ida Rantalaiho
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Toni Luokkala
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Tapio Flinkkilä
- Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Mikko Salmela
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - L Adolfsson
- Institution for Clinical and Experimental Medicine, Division of Orthopaedics, Linköping University, Linkoping, Sweden
| | - Bo Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Kari Isotalo
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Anssi Ryösä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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[Coronoid reconstruction with autologous iliac crest bone graft in chronic elbow instability through a medial approach]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:419-430. [PMID: 36074139 PMCID: PMC9729130 DOI: 10.1007/s00064-022-00783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Neutralizing a posteromedial rotatory instability (PMRI) caused by coronoid deficiency by restoration of the humeroulnar joint surface with an autologous iliac crest bone graft. INDICATIONS Surgery is indicated in patients with chronic deficiency of the anteromedial facet of the coronoid with subsequent PMRI. CONTRAINDICATIONS Coronoid reconstruction is not recommended in patients with advanced osteoarthritis of the elbow caused by subluxation of the humeroulnar joint. General contraindications like acute infection, pregnancy and lack of operability should also be taken into account. SURGICAL TECHNIQUE First, a medial approach is established and the base of the coronoid is prepared. Afterwards an autologous iliac crest bone graft is placed onto the defect and secured by screws or a plate. In addition, a reconstruction of the anterior bundle of the medial collateral ligament with an autologous tendon graft is performed. POSTOPERATIVE MANAGEMENT An elbow orthesis is worn for 6 weeks after surgery to avoid valgus or varus stress. There is no restriction in range of motion. A continuous passive motion elbow chair supports the patient in regaining elbow mobility. RESULTS Between 2015 and 2017, we treated 10 patients suffering from chronic coronoid defects with coronoid reconstruction. Eight of the patients were available for follow-up 86 weeks after surgery. The mean age was 41.4 years. In all patients, elbow range of motion and patient-related outcome measures were improved after surgery. Plain radiographs illustrated correct centering of the elbow joint. One patient had to undergo elbow arthroplasty and was excluded. Coronoid reconstruction with an autologous iliac crest bone graft restored humeroulnar joint congruency and improved satisfaction in patients suffering from chronic coronoid deficiency.
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Epidemiology of isolated olecranon fractures: a detailed survey on a large sample of patients in a suburban area. JSES Int 2022; 6:309-314. [PMID: 35252932 PMCID: PMC8888171 DOI: 10.1016/j.jseint.2021.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Kaiser P, Stock K, Benedikt S, Kastenberger T, Schmidle G, Arora R. Retrospective comparison of conservative treatment and surgery for widely displaced olecranon fractures in low-demanding geriatric patients. Arch Orthop Trauma Surg 2022; 142:2659-2667. [PMID: 34226982 PMCID: PMC9474477 DOI: 10.1007/s00402-021-04031-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the difference of the clinical outcome of elderly patients who were treated surgically or conservatively for a displaced olecranon fracture (Mayo type IIA or IIB). PATIENTS AND METHODS Patients above the age of 70 years who were treated surgically (n = 11) for a displaced Mayo type IIA and IIB olecranon fracture between July 2015 and February 2019 were retrospectively compared with patients who were treated conservatively (n = 6). The range of motion, elbow strength, grip strength, VAS, DASH, OES, MEPI and Broberg and Morrey scores were evaluated. RESULTS The conservative group showed a non-union with a persistent fracture gap of 17 mm (SD 12 mm) at the articular rim and 31 mm (15 mm) at the dorsal rim while there was no case of non-union in the surgical group. The arch of motion was 120° in the conservative group and 136° in the surgical group. There was no obvious difference in elbow extension strength in comparison to the healthy contralateral side (p = 0.20; 88% group I/87% group II). There was no difference in the OES (p = 0.30; 42 (SD 7) vs. 45 (SD 5)) and MEPI score (p = 0.46; (SD 8) vs. 96 (SD 19)). The conservative group presented a slightly worse DASH [p = 0.10; 26 (SD 25) vs 7 (SD 14)] and a significantly worse Broberg and Morrey score (p = 0.02; 84(SD 9) vs. 95 (SD 7)). The conservative group presented one complication (ulnar nerve palsy), while the surgical group presented two cases (prolonged lymphedema; blocked forearm rotation due to screw length with consecutive revision surgery). CONCLUSION Widely displaced olecranon fractures can successfully be treated conservatively in low-demanding geriatric patients with a satisfactory outcome. Patient selection is essential as patients that are more active might benefit from surgical treatment. Yet, treatment risks and benefits need to be balanced carefully in regard to the patient`s demands and requests.
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Affiliation(s)
- Peter Kaiser
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Kerstin Stock
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Stefan Benedikt
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Tobias Kastenberger
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gernot Schmidle
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Rohit Arora
- grid.5361.10000 0000 8853 2677Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Wenger D, Cornefjord G, Rogmark C. Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients. Arch Orthop Trauma Surg 2022; 142:2669-2676. [PMID: 34236459 PMCID: PMC9474339 DOI: 10.1007/s00402-021-04027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tension band wiring of olecranon fractures has high reported rates of complications and reoperations. We aimed to compare classic tension band wiring to cerclage fixation without K-wires in the treatment of displaced olecranon fractures in elderly patients. The primary outcome was reoperation. Secondary outcomes included complications and patient reported outcomes. Outcomes following non-operative treatment were also studied. MATERIALS AND METHODS Patients aged > 69 years presenting with Mayo class 2a and 2b olecranon fractures at our institution from 2004 through 2016 (n = 239) were eligible for study. Fracture type, treatment method, complications and reoperations were assessed from radiographs and hospital files. QuickDASH surveys were collected by mail. RESULTS Patients operated with tension band wire technique had more reoperations (p value 0.03): relative risk (RR) 2.2 (CI 1.08-4.3), odds ratio (OR) 2.6 (CI 1.05-6.4), and complications (p value 0.001): RR 2.5 (CI 1.51-4.1), OR 3.7 (CI 1.67-8.2), compared with those operated with cerclage technique. Non-operative treatment yielded similar complication (p value 0.2) and reoperation rates (p value 0.06) as cerclage fixation. The answer rate was insufficient to compare QuickDASH scores between treatments methods. CONCLUSIONS In patients 70 years and older undergoing cerclage fixation for displaced stable olecranon fractures (Mayo class 2), the reoperation and complications rates were less than half of those in patients undergoing TBW fixation. Non-operative treatment yielded similar reoperation and complication rates to cerclage fixation, in selected cases. LEVEL OF EVIDENCE III-retrospective comparative cohort study.
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Affiliation(s)
- Daniel Wenger
- Department of Orthopedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmo, Sweden ,Lund University, Lund, Sweden
| | | | - Cecilia Rogmark
- Department of Orthopedics, Skåne University Hospital, Inga Marie Nilssons gata 22, 205 02 Malmo, Sweden ,Lund University, Lund, Sweden
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Wong KP, Tan JCH. The effect of post-fixation olecranon lengthening on range of motion of the elbow: a cadaveric study. BMC Musculoskelet Disord 2021; 22:1045. [PMID: 34930181 PMCID: PMC8690467 DOI: 10.1186/s12891-021-04936-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Principles of fixation of comminuted olecranon fractures include anatomical reduction of the articular surface and restoration of ulnohumeral joint motion. However, comminution sometimes may not permit anatomical fixation of fracture fragments, resulting in inadvertent olecranon lengthening after plate fixation. The aim of our study is to investigate the relationship between olecranon lengthening following plate fixation and loss of elbow extension. Materials and methods Transverse olecranon osteotomies were performed on 8 cadaveric elbows. The osteotomy sites were then fixed with olecranon plates. Lengthening of the osteotomy sites were simulated by placement of 2mm, 4mm, 6mm and 8mm blocks. Lateral view photographs of the elbows were taken after each degree of lengthening. These photographs were then printed and measurements of elbow extension were performed with a goniometer with average values taken. The measurements were tabulated and statistical analysis performed to determine the relationship between degree of elbow extension loss and amount of olecranon lengthening. Results Average values of each degree of lengthening (at 2mm, 4mm, 6mm and 8mm) were taken and compared with the baseline measurement (at 0mm). Cluster analysis showed that for every increment in osteotomy length of 2mm, there is a corresponding increase of 0.79° of elbow extension loss (p<0.01, 95% confidence level 0.55°-1.03°). Conclusion Lengthening of olecranon by increments of 2mm correlates positively with loss of elbow extension. This shows that inadvertent intra-operative olecranon lengthening post-fixation may result in limited range of motion. However, it is reassuring to know that the small degree of extension loss may not translate to functional limitation.
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Affiliation(s)
- Khai Phang Wong
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
| | - James Chung Hui Tan
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
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Beaudouin E, Augustin B. Is surgery needed for displaced olecranon fractures in patients aged 75 years or over? Orthop Traumatol Surg Res 2021; 107:103089. [PMID: 34601162 DOI: 10.1016/j.otsr.2021.103089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/11/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND For displaced olecranon fractures, surgery is the standard of care in young adults but remains controversial in patients aged 75 years or over. The objective of this study was to assess the functional and radiological outcomes and to describe the complications of surgical treatment in this older population. HYPOTHESIS Surgery is the optimal treatment for displaced olecranon fractures in patients aged 75 years or over. MATERIALS AND METHODS We retrospectively reviewed the files of patients who were 75 years of age or older when they underwent surgery for displaced olecranon fractures at our centre between January 2013 and December 2017. Functional and radiological outcomes were assessed at radiological fracture healing or at last follow-up. RESULTS We included 29 patients with 30 fractures. Mean age was 82 years (range, 75-93 years). All 30 fractures were Mayo II or III, A or B. Tension-band wiring was used for 21 fractures, locked-plate fixation for 7 fractures, and double-plate fixation for 2 fractures. The mean Mayo Elbow Performance Score was 82.5 (range, 45-100). Complications occurred for 11 (37%) fractures, and the material was removed for 11 (37%) fractures. DISCUSSION The complications resulted from a mismatch between fracture type, bone quality, and the internal fixation material. Compared to tension-band wiring, plate fixation was associated with more complications, many of which required removal of the material. Tension-band wiring was not sufficient for proximal fractures and type III B fractures, for which lacing is an alternative. Conservative functional treatment remains a wise option for type II olecranon fractures in these elderly patients. Surgery is required, however, in patients with type III fractures (fracture-dislocations). LEVEL OF EVIDENCE IV, retrospective, single-centre, observational cohort study.
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Affiliation(s)
- Emmanuel Beaudouin
- Department of orthopaedic surgery and traumatology, Centre Hospitalier Métropole de Savoie, BP 31125, 73160 Chambéry cedex, France.
| | - Bermann Augustin
- Department of orthopaedic surgery and traumatology, Centre Hospitalier Métropole de Savoie, BP 31125, 73160 Chambéry cedex, France
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Metikala S, Poulos NG, Hasan K, Vallem MMR. Olecranon Fracture in an Older Adult Treated With Locking Plate Osteosynthesis. Cureus 2021; 13:e18836. [PMID: 34804691 PMCID: PMC8592798 DOI: 10.7759/cureus.18836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/12/2022] Open
Abstract
Although olecranon fractures are not uncommon in the geriatric population, there has been a considerable difference of opinion between surgical and nonsurgical treatments. Surgical treatment is usually deferred in the elderly, even for displaced olecranon fractures, because of inherent risks associated with poor bone quality and soft tissues, which often necessitate further surgeries. However, nonoperative treatment frequently results in an inability to regain full extension strength of the elbow, which can be disabling in select older adults with higher functional demands. We present an active older adult with a displaced olecranon fracture, who achieved a satisfactory result after open reduction and internal fixation (ORIF) using a low-profile locking plate.
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Affiliation(s)
| | - Nicholas G Poulos
- Orthopaedics, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Khalid Hasan
- Orthopaedics, Virginia Commonwealth University School of Medicine, Richmond, USA
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Rantalaiho IK, Laaksonen IE, Ryösä AJ, Perkonoja K, Isotalo KJ, Äärimaa VO. Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures. J Shoulder Elbow Surg 2021; 30:2412-2417. [PMID: 33774170 DOI: 10.1016/j.jse.2021.03.138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Olecranon fractures are common and usually treated operatively either by tension band wiring (TBW) or plate fixation (PF). The aim of this study was to assess early complications and reoperations and their predictive factors related to those operative methods. METHODS A retrospective analysis of all patients with an operatively treated olecranon fracture between 2007 and 2017 at Turku University hospital was performed. Reoperations, postoperative complications, and potential risk factors for these were recorded. RESULTS A total of 434 patients (387 TBW and 47 PF) were identified. There was no statistically significant difference in the rate of early complications (49% vs. 62%, P = .262) or reoperations (38% vs. 53%, P = .079) between patients treated with TBW and PF. In the TBW group, the intramedullary placement of Kirschner (K)-wires predisposed patients to complications compared to transcortical placement of the K-wires according to multivariate analysis (odds ratio [OR] 1.94, P = .026). Younger age was associated with the frequency of reoperations, the odds decreasing 24% for every 10 years of age (P < .001). Further, patients with high-energy trauma mechanisms were reoperated more often compared to patients with low-energy trauma (OR 2.99, P = .002). Also, excellent postoperative reduction was associated with higher reoperation rate than good or fair reduction (OR 0.48, P = .033). CONCLUSION There is a high risk of early complications and reoperations associated to both TBW and PF. Transcortical positioning of K-wires may reduce the rate of complications in TBW.
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Affiliation(s)
- Ida K Rantalaiho
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.
| | - Inari E Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Anssi J Ryösä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Katariina Perkonoja
- Auria Clinical Informatics, the Hospital District of Southwest Finland, Turku, Finland
| | - Kari J Isotalo
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville O Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
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Abstract
Approximately 4.1% of all fractures in the elderly involve the elbow. Most elbow injuries in geriatric patients occur as the result of low-energy mechanisms such as falls from standing height. Elbow injuries in elderly patients present complex challenges because of insufficient bone quality, comminution, articular fragmentation, and preexisting conditions, such as arthritis. Medical comorbidities and baseline level of function must be heavily considered in surgical decision making.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Julie Switzer
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Chad Myeroff
- TRIA Orthopedic Center, 155 Radio Drive, Woodbury, MN 55125, USA.
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Incidence and Management of Articular Impaction in Geriatric Olecranon Fractures. J Am Acad Orthop Surg 2021; 29:805-810. [PMID: 33999874 DOI: 10.5435/jaaos-d-20-01293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/20/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Olecranon fractures are common in the elderly. Articular impaction is encountered occasionally, but the incidence and outcomes after treatment of this injury pattern have not been well characterized. METHODS We evaluated a cohort of geriatric olecranon fractures to determine the incidence of articular impaction and describe a technique for open reduction and internal fixation. RESULTS Of the 63 patients in our series, 31 had associated intraarticular impaction (49.2%). Patients with articular impaction did not have significantly different rates of postoperative complications (11/31, 35.5% versus 10/31, 32.3%; P = 1.00) or revision surgery (10/31, 32.3% versus 8/31, 25.8%; P = 0.780) compared with those without articular impaction. CONCLUSION Articular impaction is a common feature of geriatric olecranon fractures. Surgeons must maintain a high index of suspicion and have a surgical plan in place for managing this component of the injury.
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Brüggemann A, Mukka S, Wolf O. Epidemiology, classification and treatment of olecranon fractures in adults: an observational study on 2462 fractures from the Swedish Fracture Register. Eur J Trauma Emerg Surg 2021; 48:2255-2263. [PMID: 34345928 PMCID: PMC9192377 DOI: 10.1007/s00068-021-01765-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023]
Abstract
Purpose This nationwide study aims to describe the epidemiology, fracture classification and current treatment regimens of olecranon fractures in adults. Methods We performed a descriptive study based on registered data from the Swedish Fracture Register (SFR). All non-pathological olecranon fractures reported between 1 January 2014 and 31 December 2018 in patients aged ≥ 18 years were included. Data on age, sex, injury mechanism, fracture classification (according to the modified Mayo classification system), primary treatment and seasonal variation were analyzed. We compared patients < 65 with those > 65 years regarding injury mechanism, distribution of fracture types and subsequent treatment. Results In total, 2462 olecranon fractures were identified in the SFR. Median age was 66 years and 65% were women. Of all fractures, 303 (12%) were proximal avulsion, 1044 (42%) simple central, 717 (29%) comminuted central and 398 (16%) distal olecranon fractures. Nonoperative treatment was performed in 21% of the patients < 65 and 35% of the patients > 65 years. Tension band wiring was used for most simple central fractures. Plate fixation was used in almost half of the operatively treated fractures classified as unstable comminuted central and distal olecranon fractures. Men show a higher proportion of high-energy trauma than women in both age groups. Conclusion Isolated fractures of the olecranon occur after a low-energy trauma, especially in older women (> 65 years). Non-operative treatment is common in uncomplicated fractures and operative treatment in more complex fractures nationwide. A shift to plate fixation in the more unstable fracture patterns is observed. These results may help health care providers and clinicians gain a better understanding of isolated olecranon fractures.
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Affiliation(s)
- Anders Brüggemann
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden
| | - Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden.
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