1
|
Feinstein SD, Paterno AV, Allen AD, Jewell E, Wright ST, Draeger RW. Techniques and Fixation of Olecranon Osteotomy: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:643-649. [PMID: 37790831 PMCID: PMC10543770 DOI: 10.1016/j.jhsg.2023.04.001] [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: 11/08/2022] [Accepted: 04/12/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose We aimed to characterize the incidence of complications regarding olecranon osteotomy, looking more specifically at the type of osteotomy and the fixation construct used to repair the osteotomy. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive search was performed. A study was included if it was an adult clinical study, a transverse or chevron olecranon osteotomy was performed, and the study explicitly states the fixation construct used to repair the osteotomy. A quality assessment was performed in each study prior to data extraction. Results We included 39 studies with a total of 1,445 patients. Most studies included patients who were being treated primarily for a distal humerus fracture. The overall incidence of delayed union was 27/643 (4.2%), with a higher rate in transverse osteotomy than in chevron osteotomy (5/49 (10.2%) vs 22/595 (3.7%)). Nonunion occurred in 43/811 (5.4%) of patients, with a higher rate in transverse osteotomy (6/73 (8.2%) vs. 37/712 (5.2%)). Implant failure or loss of reduction occurred in 44/746 (5.9%) of patients, with a higher rate in transverse osteotomy (11/49 (22.4%) vs 33/688 (4.8%)). The removal of implants occurred in 236/1078 (21.9%) of all patients, with the highest rate in those studies that used plate fixation 44/99 (44.4%). Conclusions Compared with chevron osteotomy, patients who underwent transverse osteotomy had a higher incidence of delayed union, nonunion, and implant failure or loss of reduction requiring revision surgery. The incidence of implant removal indicates that patients should be informed that nearly half of the osteotomy fixed with a plate was removed after implantation. Type of study/level of evidence Therapeutic III.
Collapse
Affiliation(s)
- Shawn D. Feinstein
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Anthony V. Paterno
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Andrew D. Allen
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Emily Jewell
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| | - Sarah T. Wright
- University Libraries, University of North Carolina, Chapel Hill, NC
| | - Reid W. Draeger
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
2
|
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.
Collapse
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.
| | | | | | | |
Collapse
|
3
|
Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures. Chin J Traumatol 2022; 25:145-150. [PMID: 34920951 PMCID: PMC9125722 DOI: 10.1016/j.cjtee.2021.12.001] [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: 06/27/2020] [Revised: 08/28/2021] [Accepted: 11/12/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO. METHODS Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation. RESULTS Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old). CONCLUSION BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.
Collapse
|
4
|
Spierings KE, Schoolmeesters BJ, Doornberg JN, Eygendaal D, van den Bekerom MPJ. Complications of olecranon osteotomy in the treatment of distal humerus fracture. Clin Shoulder Elb 2022; 25:163-169. [PMID: 35545245 PMCID: PMC9185118 DOI: 10.5397/cise.2021.00591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/08/2022] [Indexed: 11/25/2022] Open
Abstract
Distal humerus fractures (DHFs) are challenging to treat due to the locally complex osseous and soft tissue anatomy. Adequate exposure of the articular surface of the distal humerus is crucial when performing an anatomical reconstruction of the elbow. Even though “triceps-on” approaches are gaining popularity, one of the most commonly used surgical treatments for DHF is olecranon osteotomy. The incidence of complications related to this approach is unclear. This review was performed to assess the type and frequency of complications that occur with the olecranon osteotomy approach in the treatment of DHF. A literature search was conducted in the PubMed/Medline, Embase, and Cochrane Library digital databases up to February 2020. Only English articles describing complications of olecranon osteotomy in the treatment of DHF were included. Data on patient and surgical characteristics and complications were extracted. Statistical analysis was performed using SPSS. A total of 41 articles describing 1,700 osteotomies were included, and a total of 447 complications were reported. Of these 447 complications, wound infections occurred in 4.2% of osteotomies, of which 1.4% were deep infections and 2.8% were superficial. Problems related with union occurred in 3.7% of osteotomies, 2% of which represented non-union and 1.7% delayed union. The high risk of complications in olecranon osteotomy must be considered in the decision to perform this procedure in the treatment of DHF.
Collapse
|
5
|
Somerson JS, Morrey ME, Sanchez-Sotelo J, Morrey BF. Predictors of reoperation after internal fixation of intra-articular distal humerus fractures. Shoulder Elbow 2022; 14:76-83. [PMID: 35154407 PMCID: PMC8832696 DOI: 10.1177/1758573219895972] [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] [Received: 05/06/2019] [Revised: 08/19/2019] [Accepted: 11/27/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite good reported outcomes with open reduction and internal fixation of intra-articular distal humerus fractures, complication rates remain high. The objective of this work is to identify factors associated with reoperation. METHODS Sixty-three patients treated with open reduction and internal fixation for intra-articular (Arbeitsgemeinschaft für Osteosynthesefragen type C) distal humerus fractures between 2004 and 2010 were identified using an institutional trauma registry, 62 of which were followed for a minimum of six months. Age, gender, fracture subclassification, open fracture presence, Injury Severity Score, time to definitive surgery, length of postoperative immobilization, and type of approach were recorded. Multivariate analysis was utilized to identify factors independently associated with reoperation. RESULTS Complications requiring reoperation developed in 25 (40.3%) elbows. The most common reasons were wound dehiscence or infection in nine elbows (14.5%) and symptomatic hardware in six (9.6%). During multivariate analysis, only olecranon osteotomy remained an independent predictor for reoperation (P = 0.043). DISCUSSION Despite improved internal fixation techniques, a high proportion of elbows require reoperation after open reduction and internal fixation for distal humerus fractures. Higher complication rates in fractures fixed through an olecranon osteotomy may reflect additional reoperations due to nonunion of the osteotomy or need to remove hardware from the ulna. LEVEL OF EVIDENCE Prognostic Level III.
Collapse
Affiliation(s)
- Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, USA,Jeremy S Somerson, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 2.316 Rebecca Sealy, 301 University Blvd Route 0165, Galveston, TX 77555-0165, USA.
| | | | | | | |
Collapse
|
6
|
Hess S, Bürki A, Moor BK, Bolliger L, Zysset P, Zumstein MA. A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for step-cut olecranon osteotomy. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:414-420. [PMID: 37588712 PMCID: PMC10426472 DOI: 10.1016/j.xrrt.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Olecranon osteotomies are frequently used to expose distal humeral intraarticular fractures. The step-cut olecranon osteotomy (SCOOT) is an augmented version of the oblique olecranon osteotomy, which has recently been evaluated biomechanically with tension band wiring (TBW) fixation. However, complications with TBW are common. In this study, we, therefore, compared the mean load to failure of TBW with compression screws for SCOOT fixation. We hypothesized a higher load to failure for the compression screw group. Methods We performed a SCOOT on 36 Sawbones. Eighteen were fixed with TBW, and another 18 with two compression screws. The humeroulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna, while the humeroulnar joint is in a fixed position. Eight models of each fixation group were tested at 20°, and eight at 70° of flexion by isometrical loading until failure, which was defined as either a complete fracture or gap formation of more than 2 mm at the osteotomy site. Results At 20° of flexion, mean load to failure was similar between the TBW group (1360 ± 238 N) and the compression screw group (1401 ± 261 N) (P = .88). Also, at 70° of flexion, the mean load to failure was similar between the TBW group (1398 ± 215 N) and the compression screw group (1614 ± 427 N) (P = .28). Conclusions SCOOTs fixed with TBW and compression screws showed similar loads to failure. A SCOOT fixed with compression screws might be a valuable alternative for surgeons when treating intraarticular distal humeral fractures. However, future in vivo studies are necessary to confirm our results in a clinical setting.
Collapse
Affiliation(s)
- Silvan Hess
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | | | - Beat K. Moor
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | - Lilianna Bolliger
- Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern Switzerland
| | | | - Matthias A. Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland
| |
Collapse
|
7
|
Wilson ES, Buckwalter JA, Henning G, Davison J, Fleury IG, Willey MC. Inclusion of Olecranon Osteotomy With the Posterior Approach for Fixation of Distal Humerus Fractures (OTA/AO 13) Does Not Increase Surgical Complications. J Orthop Trauma 2021; 35:e223-e227. [PMID: 33208714 DOI: 10.1097/bot.0000000000002006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine if inclusion of an olecranon osteotomy to the posterior paratricipital approach for operative fixation of distal humerus fractures significantly affects surgical complication rates (OTA/AO 13). DESIGN Retrospective comparative cohort study. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Three hundred four patients underwent open reduction internal fixation of a distal humerus fracture between 2007 and 2017. Of those, 134 met inclusion criteria (≥15 years, OTA/AO fracture type 13A, B, or C, and posterior surgical approach) for the study (n = 64 with olecranon osteotomy; n = 70 without olecranon osteotomy). INTERVENTION Open reduction internal fixation of distal humerus fractures performed using a posterior paratricipital approach with or without olecranon osteotomy. MAIN OUTCOME MEASURE Ulnar neuropathy (UN), fracture site bony nonunion, and surgical site infection (SSI). RESULTS Thirty-one (33.3%) who underwent the paratricipital approach without olecranon osteotomy, and 15 patients (26.8%) who underwent olecranon osteotomy reported postoperative UN with no significant difference between approaches (P = 0.438). There was no significant difference in rates of SSI (P = 0.418) or fracture site nonunion (P = 0.263) when comparing the approaches. Subjects with Charlson comorbidity index ≥2 were more likely to not undergo an olecranon osteotomy (P = 0.01), whereas subjects with more complex fractures by OTA/AO classification were more likely to have an olecranon osteotomy approach (P = 0.001). CONCLUSIONS Addition of an olecranon osteotomy with the paratricipital approach for fixation of distal humerus fractures does not result in higher rates of UN, fracture site nonunion, or SSI. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Erin S Wilson
- University of Iowa, Carver College of Medicine, Iowa City, IA; and
| | - Joseph A Buckwalter
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Grant Henning
- University of Iowa, Carver College of Medicine, Iowa City, IA; and
| | - John Davison
- University of Iowa, Carver College of Medicine, Iowa City, IA; and
| | - Ignacio G Fleury
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Michael C Willey
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA
| |
Collapse
|
8
|
Meldrum A, Kwong C, Archibold K, Cinats D, Schneider P. Olecranon Osteotomy Implant Removal Rates and Associated Complications. J Orthop Trauma 2021; 35:265-270. [PMID: 33086235 DOI: 10.1097/bot.0000000000001979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study reports on olecranon osteotomy implant removal rates, fixation types, and associated complications. DESIGN Multicentre case series. SETTING Patients were identified through an electronic medical database at one Level 1 trauma center and three Level 2 trauma centers. PATIENTS Two hundred thirty-five patients were identified through the database, of which 92 patients met inclusion criteria. INTERVENTION Patients underwent olecranon osteotomy for fixation of distal humerus fractures and the implant used was at the surgeon's discretion. MAIN OUTCOME MEASUREMENT Implant removal rate. RESULTS Thirty-four of 92 (37.0%) patients underwent removal of implant from their olecranon osteotomy. Implant removal rates were as follows: 28 of the 63 patients for tension band wiring (TBW) (44.4%), 6 of the 18 patients for plates (33.3%), 0 of the 1 patient for cable-pin, and 0 of the 10 patients for osteotomies fixed with a screw fixation. Screw fixation was removed less frequently than TBW (P = 0.01). Screws were less commonly removed than all other fixation types (P = 0.01). TBWs (28/63) were more commonly removed than all other implants (6/29) (P < 0.05). The nonunion rate for olecranon osteotomies was 3.3%. TBWs (18/18) are more likely to be removed for implant irritation than plates. TBWs had an odds ratio of 3.29 for requiring implant removal if they were left >1 mm off of the olecranon tip. CONCLUSION In this study, 34 of the 92 (37%) patients undergoing an olecranon osteotomy for treatment of a distal humerus fracture required removal of olecranon implant. Screw fixation (0/10) was found to be removed less frequently than TBW fixation 28 of the 63 patients (44.4%). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexander Meldrum
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Cory Kwong
- Southern California Orthopaedic Institute, University of Los Angeles, Los Angeles, CA
| | | | - David Cinats
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, NY; and
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
9
|
Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures. Orthop Traumatol Surg Res 2021; 107:102641. [PMID: 33129752 DOI: 10.1016/j.otsr.2020.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/23/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Supra- and intercondylar elbow fractures are surgically challenging given the intra-articular comminution. Various surgical approaches have been described. Among these-olecranon osteotomy-provides optimal joint exposure but is associated with several complications. Tension band wiring (TBW) is the most commonly used fixation method. We hypothesized that double screw fixation would lead to fewer surgical revisions than TBW (all causes included) after olecranon osteotomy. METHODS We carried out a single-center retrospective study of 39 patients, treated between January 2007 and April 2016, for a supra- or intercondylar elbow fracture using the transolecranon exposure. There were 34 type C fractures (13 C1, 6 C2 and 15 C3), 3 type B fractures and 2 type A fractures, based on the AO classification. Fourteen patients received double screw fixation and 25 received TBW. The primary outcome measure was the number of surgical revisions, regardless of cause. Secondary outcome measures were the number of surgical revisions for olecranon nonunion, fixation failure or fixation device removal due to pain. RESULTS There were significantly more surgical revisions in the TBW group than in the double screw fixation group: 3 (21%) versus 14 (56%) (p=0.049, Fisher test). The three main reasons for revision in the TBW and double screw fixation groups were removal of the fixation device due to soft tissue impingement (11 [44%] versus 2 [14%]; p=0.08), failure of the olecranon fixation (6 [24%] versus 1 [7%] p=0.38), and olecranon nonunion (4 [16%] versus 0 [0%] p=0.27). DISCUSSION There are no published studies on the outcomes of this surgical technique. The posterior transolecranon approach provides the best exposure at the elbow joint. TBW fixation is associated with multiple complications. Double screw fixation for olecranon fractures yields good clinical and radiological outcomes. CONCLUSION Based on our findings, double screw fixation of the olecranon results in fewer surgical revisions (all causes combined) than TBW in supra- and intercondylar elbow fractures operated by a transolecranon approach. LEVEL OF EVIDENCE IV.
Collapse
|
10
|
Cañete San Pastor P, Lopez Valenciano J, Copete I, Prosper Ramos I. Fixation of olecranon osteotomy only with 6'5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures. J Exp Orthop 2021; 8:4. [PMID: 33433762 PMCID: PMC7803853 DOI: 10.1186/s40634-020-00317-8] [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: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The objective of this study is to demonstrate the safety and efficacy of the osteosynthesis with a 6.5 mm screw and washer of a Chevron shape olecranon osteotomy performed for the surgical approach of supraintercondylar fractures of the distal humerus, achieving union and complication rates better or similar to other published case series. METHODS From 2009 to 2019, 26 patients underwent fixation of an olecranon osteotomy for the treatment of a supraintercondylar fracture of the distal humerus with partially threaded cancellous cannulated screws of 6.5 mm diameter with a washer. The patients were followed for at least 1 year, taking radiographs the day after the surgery, at 3, 6 and 12 months. Complications have been collected: infection, loss of reduction, non-union, delay of union, discomfort of the osteosynthesis hardware. The diameter of the ulna medullary canal diaphysis was also measured in all patients. RESULTS Consolidation of the osteotomy was 100% at 12 months. The average time of radiological consolidation was 112 ± 12 days. The average size of the ulna medullary canal diaphysis was 6'06 ± 0'16 mm on anteroposterior radiographs and 5'65 ± 0'14 mm on lateral radiographs. The mean screw length was 102'31 mm ± 3'89. We found 1 acute infection, 2 osteotomies delays of union (one of these cases was the acute infection case), one early osteosynthesis failure and 1 wound dehiscence. CONCLUSIONS Olecranon ostetomy fixation with a 6'5 mm cancelous partial threaded screw and washer is safe and effective with a high consolidation rate and excellent results and with complication rates similar to or lower than other fixation methods published. Long enough screws must be used to get a good cortical grip with enough stability. LEVEL OF EVIDENCE Level IV, Case series, retrospective review.
Collapse
Affiliation(s)
| | | | - Ivan Copete
- Orthopaedic Surgery Department, Hospital de Manises, Valencia, Spain
| | | |
Collapse
|
11
|
Augmented intramedullary screw tension band construct for olecranon fracture reduction and fixation: a review of literature and surgical technique. JSES Int 2020; 4:470-477. [PMID: 32939470 PMCID: PMC7479051 DOI: 10.1016/j.jseint.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Olecranon fractures, which make up 10% of upper extremity fractures in adults, often require anatomic reduction and stable internal fixation. Successful olecranon fracture osteosynthesis has classically been achieved via tension band wiring or plate fixation. This article reviews the indications, outcomes, and a surgical technique as an alternative construct for tension band wiring of olecranon fractures. The technique involves placement of an ulnar intramedullary partially threaded screw that is used as a proximal point of attachment for tension band wiring of the olecranon. Although infrequently used by orthopedic surgeons, this construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques. This review is intended to familiarize surgeons with a surgical technique that can be applied to a variety of proximal ulna fractures.
Collapse
|
12
|
Goetti P, Behrends DA, Gallusser N, Terrier A, Becce F, Vauclair F. Predrilled locking compression plate is more accurate than tension band wiring in restoring articular geometry of the ulnar greater sigmoid notch after olecranon Chevron osteotomy. Injury 2020; 51:1597-1602. [PMID: 32430193 DOI: 10.1016/j.injury.2020.04.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/14/2020] [Accepted: 04/25/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The olecranon Chevron osteotomy (OCO) is commonly used to approach complex intra-articular fractures of the distal humerus. Predrilled tension band wiring (TBW) has historically been used to fix OCO. However, clinical outcomes are burdened by secondary loss of reduction and up to 21.3% non-union rates. The biomechanical stability of anatomic locking compression plate (LCP) was reported to be superior to TBW in olecranon fracture fixation. We hypothesised that this implant may also be superior to TBW in the anatomic reconstruction of the articular surfaces of the ulnar greater sigmoid notch after OCO by predrilling the holes of the angular stable plate with the threaded drill guide prior to osteotomy. MATERIALS AND METHODS Lateral standardised and calibrated radiographs of twenty synthetic ulnar bones were obtained using a custom-made holder prior to preparation by a senior orthopaedic trauma surgeon. Ten specimens were then predrilled using the threaded drill bit guide of an olecranon LCP, while the other ten samples were predrilled with two 1.6 mm Kirschner wires. A distal "V" OCO was performed using a 0.6 mm oscillating saw. After repositioning and fixation with the corresponding device, lateral radiographs were repeated. Two independent observers used the TraumaCad planning software to document the articular geometry of the ulnar greater sigmoid notch pre- and postoperatively. The diameter of the best-fitting circle (diameter), the distance between the tip of the coronoid and the olecranon processes (distance) and the maximum articular depth were measured. RESULTS With the TBW technique, after OCO and fixation, all three postoperative measurements were significantly (p≤0.001) different from preoperative measurements. The diameter and distance increased by a mean of 1.5±0.5 mm and 0.9±0.3 mm, respectively, while the depth decreased by a mean of 0.2±0.1 mm. In contrast, no significant differences between pre- and postoperative measurements were observed with the LCP technique (p≥0.13). Inter and intra-observer measurement reliability was strong to very strong (intraclass correlation coefficients≥0.793) for all three variables. CONCLUSION Our study reveals that the predrilled LCP technique is more accurate than the predrilled TBW in restoring the anatomic articular geometry of the ulnar greater sigmoid notch after OCO.
Collapse
Affiliation(s)
- Patrick Goetti
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Dominique Andre Behrends
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Nicolas Gallusser
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 19, 1015 Lausanne.
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Frédéric Vauclair
- Department of Orthopaedics and Traumatology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| |
Collapse
|
13
|
Sinha S, Maharjan R, Khanal GP, Pokharel B, Drolia N, Gupta S, Kanojia RK, Chaudhary P. Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation-A Randomised Controlled Study. Strategies Trauma Limb Reconstr 2020; 15:131-137. [PMID: 34025792 PMCID: PMC8121108 DOI: 10.5005/jp-journals-10080-1510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To compare the clinical and radiological outcomes of fixation of olecranon fractures by a transcortical screw with conventional tension band wiring (TBW) using a Kirschner wire (K-wire). Materials and methods This is a non-blinded randomised controlled trial comprising two groups (n = 30 each) with Mayo type A olecranon fractures fixed with either TBW or transcortical cancellous screws (CCS). Outcomes included the Mayo elbow performance index (MEPI), time to union, range of motion (ROM), and rates of complication among these two groups. Results Most of the patients showed excellent scoring as per MEPI in both the groups at 6 weeks (90% in TBW group and 76.7% in CCS group) and were not significant (p = 0.719). Signs of the radiological union were noted in 80% of the cases at 6 weeks and complete at 6 months. Hardware-related complications (8.3% symptomatic hardware and 6.7% implant back-out), infection, and mean ROM were similar between the two groups (elbow flexion was 142.33 ± 24.67° in TBW group and 143.1 ± 10.19° in transcortical screw group, p = 0.246) at the end of the study. Conclusion There were no statistically significant differences in the clinical–radiological outcomes and complications fixing the non-comminuted olecranon fractures with either transcortical screw or TBW. Clinical significance Transcortical screw fixation is an acceptable alternative to TBW for non-comminuted olecranon fractures in terms of union and functional outcome. How to cite this article Sinha S, Maharjan R, Khanal GP, et al. Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation—A Randomised Controlled Study. Strategies Trauma Limb Reconstr 2020;15(3):131–137.
Collapse
Affiliation(s)
- Siddhartha Sinha
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Rajiv Maharjan
- Department of Orthopaedics, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Guru P Khanal
- Department of Orthopaedics, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bishnu Pokharel
- Department of Orthopaedics, B P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nikhil Drolia
- Patliputra Multispeciality Hospital, Dhanbad, Jharkhand, India
| | - Sumit Gupta
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Rajesh K Kanojia
- Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India
| | - Pashupati Chaudhary
- Department of Orthopaedics, B P Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
14
|
Wei L, Ling M, An Z. Biomechanical analysis of a novel plating for intra-articular distal humerus fractures: combined anteromedial and anterolateral plating. J Orthop Surg Res 2019; 14:132. [PMID: 31088497 PMCID: PMC6518756 DOI: 10.1186/s13018-019-1181-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/30/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose The traditional strategy for fixing intra-articular distal humerus fractures is double plating placed in an orthogonal or parallel configuration, based on posterior approach. With a combined medial and lateral approach, a novel configuration of plating (combined anteromedial and anterolateral plating) has been used. In this study, we investigated the biomechanical properties of the novel plating by comparing it with orthogonal plating. Methods Based on the 3D morphology of a healthy subject’s humerus, the models of simple intra-articular distal humerus fractures were simulated. Two configurations of plating were applied to fix the models: the novel plating (with one plate anteromedially and the other anterolaterally on distal humerus), and orthogonal plating. Stresses, displacement, and stiffness were simulated and calculated under the conditions of axial compression, rotation torsion, bending torsion, and valgus torsion by using finite element analysis. Results In all the conditions, the maximal von Mises stresses of the novel plating are similar to those of orthogonal plating, and the patterns of stress distribution are similar between these two configurations. However, the impact of high stresses was weaker on the novel plating. The maximal displacement of the novel plating is smaller than that of orthogonal plating. The stiffness of the novel plating is superior to that of orthogonal plating, with the improvements of 19.4%, 122.7%, 25.0%, and 54.2% in axial compression, rotation torsion, bending torsion, and valgus torsion, respectively. Conclusions The novel plating is stronger than orthogonal plating without increasing stress magnitude when fixing simple intra-articular distal humerus fractures, which makes it a feasible alternative. Further biomechanical and clinical studies are needed for a decisive conclusion.
Collapse
Affiliation(s)
- Libiao Wei
- Department of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Ming Ling
- Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Zhiquan An
- Department of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| |
Collapse
|
15
|
Bosman WMPF, Emmink BL, Bhashyam AR, Houwert RM, Keizer J. Intramedullary screw fixation for simple displaced olecranon fractures. Eur J Trauma Emerg Surg 2019; 46:83-89. [PMID: 30879100 PMCID: PMC7026218 DOI: 10.1007/s00068-019-01114-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/11/2019] [Indexed: 01/11/2023]
Abstract
Purpose Olecranon fractures are common and typically require surgical fixation due to displacement generated by the pull of the triceps muscle. The most common techniques for repairing olecranon fractures are tension-band wiring or plate fixation, but these methods are associated with high rates of implant-related soft-tissue irritation. Another treatment option is fixation with an intramedullary screw, but less is known about surgical results using this strategy. Thus, the purpose of this study was to report the clinical and functional outcomes of olecranon fractures treated with an intramedullary cannulated screw. Methods We identified 15 patients (average age at index procedure 44 years, range 16–83) with a Mayo type I or IIA olecranon fracture who were treated with an intramedullary cannulated screw at a single level 2 trauma center between 2012 and 2017. The medical record was reviewed to assess radiographic union, postoperative range of motion and complications (including hardware removal). Patient-reported outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Average follow-up was 22 months (range 8–36 months). Results By the 6th month post-operative visit, 14 patients had complete union of their fracture and 1 patient had an asymptomatic non-union that did not require further intervention. Average flexion was 145° (range 135–160) and the average extension lag was 11° (range 0–30). Implants were removed in 5 patients due to soft-tissue irritation. Average DASH score (± standard deviation) by final follow-up was 16 ± 10. Conclusions Fixation of simple olecranon fractures with an intramedullary screw is a safe and easy fixation method in young patients, leading to good functional and radiological results. Compared to available data, less hardware removal is necessary than with tension-band wiring or plate fixation.
Collapse
Affiliation(s)
- Willem-Maarten P F Bosman
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands.
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
| | - Benjamin L Emmink
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
- Department of Trauma Surgery, University Medical Center, Utrecht, The Netherlands
| | - Abhiram R Bhashyam
- Department of Trauma Surgery, University Medical Center, Utrecht, The Netherlands
- Harvard Combined Orthopaedic Residency Program, Harvard University, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - R Marijn Houwert
- Department of Trauma Surgery, University Medical Center, Utrecht, The Netherlands
| | - Jort Keizer
- Department of Surgery, St Antonius Hospital, Utrecht, The Netherlands
| |
Collapse
|
16
|
Kia C, Dukas AG, Marshall ST, Voss A, Obopilwe E, Browner BD, Mazzocca AD. Biomechanical Comparison of Olecranon Sled Versus Intramedullary Screw Tension Banding for Olecranon Osteotomies. Orthop J Sports Med 2018; 6:2325967118816075. [PMID: 30574518 PMCID: PMC6299312 DOI: 10.1177/2325967118816075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Olecranon osteotomies are frequently performed to gain access to the distal humeral articular surface. Repair of the osteotomy or fixation of a simple 2-part olecranon fracture with traditional tension band construct is often plagued by complication. Proximal migration and irritation attributed to hardware are common complications of the standard construct of an intramedullary screw with tension band and are causes for reoperation. Purpose: To compare the biomechanical performance, time of implant, and prominence of an intramedullary screw and tension band construct with that of a newer low-profile continuous loop tension band (Olecranon Sled) construct in an olecranon osteotomy model. Study Design: Controlled laboratory study. Methods: Chevron osteotomies were created in 6 matched pairs of fresh-frozen human elbows (mean age, 66 ± 16 years). Each matched pair was then randomly divided into 1 of 2 groups: fixation with a screw and tension band construct or the Olecranon Sled. Bone mineral density, implant prominence, and time for implantation were recorded. Following olecranon fixation, each specimen underwent cyclic loading of 0 to 10 N for 100 cycles (to simulate unresisted active range of motion) and then 0 to 500 N for 500 cycles (to simulate pushing up from a chair) to measure for any displacement at the osteotomy site. The constructs were then loaded to failure and compared. Results: No differences were found in bone mineral density between the 2 groups (P = .290). When measured from the tip of the olecranon, the continuous loop tension band had a medial prominence of only 3.57 ± 0.4 mm, as opposed to the intramedullary screw fixation of 7.288 ± 0.762 mm (P = .027). Total time of implantation, including osteotomy preparation, was a mean 155 seconds shorter with the Olecranon Sled versus the traditional tension band (P < .05). Because of the fracture of 1 specimen during cyclic loading, it and its matched counterpart were excluded, and only 5 matched pairs were analyzed for displacement and load to failure. There were no significant differences between groups in load to failure or displacement during cyclic loading (P > .05). Conclusion: The Olecranon Sled device was found to have no difference in biomechanical strength from that of the standard intramedullary screw with tension band construct. The Olecranon Sled was also found to be significantly less prominent while being faster to implant than the intramedullary screw. Clinical Relevance: Evaluating an alternative option to the standard tension band construct is important for patients with olecranon fractures or osteotomies, as standard techniques have been fraught with hardware issues and need for revision surgery.
Collapse
Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, USA
| | - Alex G Dukas
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, USA
| | - Silas T Marshall
- Proliance Orthopaedic & Sports Medicine, Bellevue, Washington, USA
| | - Andreas Voss
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, USA
| | - Bruce D Browner
- Department of Orthopaedic Surgery, Duke University Health System, Durham, North Carolina, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, USA
| |
Collapse
|
17
|
Savvidou OD, Zampeli F, Koutsouradis P, Chloros GD, Kaspiris A, Sourmelis S, Papagelopoulos PJ. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev 2018; 3:558-567. [PMID: 30662764 PMCID: PMC6335604 DOI: 10.1302/2058-5241.3.180009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of distal humerus fractures is demanding. Surgery is the optimal treatment and preoperative planning is based on fracture type and degree of comminution. Fixation with two precontoured anatomical locking plates at 90o:90o orthogonal or 180o parallel is the optimal treatment. The main goal of surgical treatment is to obtain stable fixation to allow immediate postoperative elbow mobilization and prevent joint stiffness. Despite evolution of plates and surgical techniques, complications such as mechanical failure, ulnar neuropathy, stiffness, heterotopic ossification, nonunion, malunion, infection, and complications from olecranon osteotomy are quite common. Distal humerus fractures still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
Cite this article: EFORT Open Rev 2018;3:558-567. DOI: 10.1302/2058-5241.3.180009
Collapse
Affiliation(s)
- Olga D Savvidou
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Frantzeska Zampeli
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | | | - George D Chloros
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Aggelos Kaspiris
- Department of Trauma and Orthopaedics, Thriasio General Hospital-NHS, Athens, Greece
| | - Savas Sourmelis
- First Department of Orthopaedics, Hygeia Hospital, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedic Surgery, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| |
Collapse
|
18
|
Abstract
Although implant removal is common after orthopedic trauma, indications for removal remain controversial. There are few data in the literature to allow evidence-based decision-making. The risk of complications from implant removal must be weighed against the possible benefits and the likelihood of improving the patient's symptoms.
Collapse
|
19
|
Kural C, Ercin E, Erkilinc M, Karaali E, Bilgili MG, Altun S. Bicolumnar 90-90 plating of AO 13C type fractures. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:128-132. [PMID: 28341102 PMCID: PMC6197599 DOI: 10.1016/j.aott.2016.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/11/2016] [Accepted: 09/23/2016] [Indexed: 11/18/2022]
Abstract
Objective The aim of this study was to evaluate functional results and complication rate of patients who underwent medial-dorsolateral plating for intra-articular distal humeral fracture (Müller AO type 13C). Methods Twenty-four patients (14 men, 10 women; mean age: 47 years) with AO type 13C distal humerus fracture were included in the study. Mean follow-up time was 28 months. Nine patients were in 13C1 subgroup, according to AO classification system, 11 patients were categorized as 13C2, and 4 patients were 13C3. Final follow-up assessment of outcomes included Broberg and Morrey radiological criteria; Mayo Elbow Performance Score, disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure, score based on Jupiter criteria; and range of motion (ROM) values. Results The mean carrying angle of operated elbows was 11.37° (range: 0-20°). According to Broberg and Morrey radiological criteria, 14 patients, had radiologically normal elbow, 4 patients had mild change, 3 patients had moderate change, and 3 patients had severe radiological change. Mean DASH score was 21.91 (range: 0-50), and mean Mayo rating was 83.37 (range: 55-100). Jupiter criteria evaluation revealed excellent results in 10 cases, good in 12, and fair results in 2. One patient with fair result had open fracture, and the other had previous hemiparesis in the same extremity. There was no instance of nonunion observed at follow-up. Conclusion Osteosynthesis with medial-dorsolateral plating is a safe and effective method for the treatment of intra-articular fractures of distal humerus. Level of evidence Level IV, Therapeutic study.
Collapse
|
20
|
Elbow fractures: current concepts. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Abstract
Distal humerus fractures are challenging injuries for the upper extremity surgeon. However, recent techniques in open reduction internal fixation have been powerful tools in getting positive outcomes. To get such results, the surgeon must be aware of how to properly use these techniques in their respective practices. The method of fixation depends on the fracture, taking the degree of comminution and the restoration of the columns and articular surface into account. This article helps surgeons understand the concepts behind open reduction internal fixation of the distal humerus and makes them aware of pitfalls that may lead to negative results.
Collapse
Affiliation(s)
- Mark A Mighell
- The American Board of Orthopaedic Surgery, 400 Silver Cedar Court, Chapel Hill, NC 27514, USA; Department of Orthopaedic Surgery, University of South Florida, 13220 USF Laurel Drive, Tampa, FL 33612, USA; Florida Orthopaedic Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA; Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Brent Stephens
- Florida Orthopaedic Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA
| | - Geoffrey P Stone
- Florida Orthopaedic Institute, 13020 Telecom Parkway North, Tampa, FL 33637, USA
| | - Benjamin J Cottrell
- Foundation for Orthopaedic Research and Education, 13020 Telecom Parkway North, Tampa, FL 33637, USA
| |
Collapse
|
22
|
Plate and Screw Fixation of Bicolumnar Distal Humerus Fractures: Factors Associated With Loosening or Breakage of Implants or Nonunion. J Hand Surg Am 2015; 40:2045-2051.e2. [PMID: 26319772 DOI: 10.1016/j.jhsa.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors associated with reoperation for early loosening or breakage of implants or nonunion after operative treatment of AO type C distal humerus fractures. METHODS We retrospectively analyzed 129 adult patients who had operative treatment of an isolated AO type C distal humerus fracture at 1 of 5 hospitals to determine factors associated with reoperation for early loosening or breakage of implants or nonunion. RESULTS Within 6 months of original fixation, 16 of 129 fractures (12%) required reoperation for loosening or breakage of implants (n = 8) or nonunion (n = 8). In bivariate analyses, the Charlson comorbidity index, smoking, a coded diagnosis of obesity, diabetes mellitus, and radiographic osteoarthritis were significantly associated with reoperation for early loosening or breakage of implants or nonunion. CONCLUSIONS With the numbers available, patient factors rather than technical factors were associated with reoperation for loosening or breakage of implants and nonunion. Because of the relative infrequency of fixation problems and nonunion, a much larger study is needed to address technical deficiencies.
Collapse
|