1
|
Savvidou OD, Koutsouradis P, Kaspiris A, Naar L, Chloros GD, Papagelopoulos PJ. Displaced olecranon fractures in the elderly: outcomes after non-operative treatment - a narrative review. EFORT Open Rev 2020; 5:391-397. [PMID: 32818066 PMCID: PMC7407865 DOI: 10.1302/2058-5241.5.190041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Operative treatment with tension band wiring or plate is the gold standard of care for displaced olecranon fractures. In elderly patients, multiple comorbidities combine with increased intraoperative risks, and postoperative complications may yield poor results. There are small series in the literature that show promising results with non-operative treatment. Non-operative treatment may provide reasonable function and satisfaction in the elderly population and could be considered as a treatment option in this group, especially for those with comorbidities, to avoid postoperative complications and the need for re-operation.
Cite this article: EFORT Open Rev 2020;5:391-397. DOI: 10.1302/2058-5241.5.190041
Collapse
Affiliation(s)
- Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | | | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece
| | - Leon Naar
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | - George D Chloros
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| |
Collapse
|
2
|
Dizdarevic I, Eden CM, Bengard M, Barron OA, Catalano LW, Glickel SZ. Assessment of Intra-articular Screw Penetration During Radial Head and Olecranon Locking Plate Fixation: A Cadaveric Study. Hand (N Y) 2016; 11:65-71. [PMID: 27418892 PMCID: PMC4920513 DOI: 10.1177/1558944715614862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the role of radiographic and clinical exams in predicting screw penetration into the proximal radioulnar joint and ulnohumeral joint during open reduction and internal fixation of the radial head and proximal ulna. METHODS Olecranon and radial head plates were applied to 15 cadaveric elbows. Screws were assessed for intra-articular joint penetration using both clinical exam and radiographic evaluation. Clinical exam consisted of evaluation for crepitus. Radiographs demonstrating screws positioned near the joint surface were evaluated for penetration by 3 fellowship trained hand surgeons. Elbows were disarticulated and screw prominence was determined and recorded using standardized calipers. The ability of clinical and radiographic exams to correctly predict a breach in the articular surface was determined by calculating sensitivity, specificity, and predictive values. Consideration was given to screw position. RESULTS The sensitivity of crepitus was 81.1% for screws in the radial head plate and 72.6% for screws in the olecranon plate. The sensitivity of radiographs was 72.4% for the screws in the radial head plate and 55.0% for screws in the olecranon plate. Correct radiographic assessment of penetration varied but position o-2 on the olecranon plate consistently resulted in the lowest sensitivity of 30.3%. CONCLUSIONS The study evaluates sensitivity and specificity of clinical and radiographic means when assessing for articular penetration of screws during olecranon and radial head locking plate fixation. Certain screw locations are more difficult to evaluate than others and may go undetected by standard means of assessment used in a surgical setting.
Collapse
Affiliation(s)
| | - Claire M. Eden
- Mt. Sinai St. Luke’s-Roosevelt Hospital, New York, NY, USA
| | | | | | - Louis W. Catalano
- Mt. Sinai St. Luke’s-Roosevelt Hospital, New York, NY, USA,Louis W. Catalano III, C. V. Starr Hand Surgery Center, Mt. Sinai St. Luke’s-Roosevelt Hospital, 1000 Tenth Avenue, 3rd Floor, New York, NY 10019, USA.
| | | |
Collapse
|
3
|
Willinger L, Lucke M, Crönlein M, Sandmann GH, Biberthaler P, Siebenlist S. Malpositioned olecranon fracture tension-band wiring results in proximal radioulnar synostosis. Eur J Med Res 2015; 20:87. [PMID: 26514829 PMCID: PMC4625882 DOI: 10.1186/s40001-015-0184-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022] Open
Abstract
Background Tension-band wiring (TBW) is a well-established fixation technique for two-part, transverse fracture types of the olecranon. However, complication rates up to 80 % are reported. By reporting on the enormous impact on the patient if failed the aim of the present report was to emphasize the importance of correct K wire positioning in TBW. Case presentation We present the case of a 49-year-old woman who suffered from a radioulnar synostosis of the forearm due to malpositioned K wires after TBW treatment. The patient was treated by heterotopic bone resection supported by ossification prophylaxis (radiotherapy and Indomethacin). At follow-up of 12 months after revision surgery, elbow motion was unrestricted with a strength grade 5/5. The patient was free of pain and reported no restrictions in daily as well as sporting activities. Radiologic assessment showed no recurrence of heterotopic bone tissue. Conclusion Intraoperative radiographic and clinical examination of the elbow is highly recommended to identify incorrect hardware positioning and, therefore, to avoid serious postoperative complications in TBW.
Collapse
Affiliation(s)
- Lukas Willinger
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Martin Lucke
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Gunther H Sandmann
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| |
Collapse
|
4
|
Enad JG, Douglas TJ, Ruland RT. Proximity of arteries to the anterior ulna with changing flexion. Orthopedics 2015; 38:e253-6. [PMID: 25901616 DOI: 10.3928/01477447-20150402-51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/24/2014] [Indexed: 02/03/2023]
Abstract
During surgery for elbow fracture, wires and screws crossing the elbow from posterior to anterior place the brachial and ulnar arteries at risk for inadvertent penetration. The authors' goal was to define the sagittal proximity of the brachial and ulnar arteries to the proximal ulna throughout an arc of elbow motion using dynamic fluoroscopy. The brachial artery was injected with barium in 10 fresh-frozen cadaveric elbows. Sagittal fluoroscopic images were obtained at elbow flexion angles of 0°, 30°, 60°, 90°, and 120°. Two measurements were obtained at each flexion angle: (1) the distance between the coronoid tip and the brachial artery and (2) the distance between the coronoid base and the ulnar artery. One-way analysis of variance was used to compare mean distances for each flexion angle within each measurement group. A coronal image identified the mediolateral course of the brachial artery. The distance from the coronoid tip to the brachial artery significantly increased with increasing flexion from 0° to 60° (P<.001). The distance from the ulnar artery to the coronoid base significantly increased with increasing flexion from 0° to 120° (P<.002). The brachial artery traversed lateral to the coronoid in 9 of 10 specimens. The brachial and ulnar arteries are located further from the coronoid with increasing elbow flexion to at least 60°, and the brachial artery is typically located lateral to the coronoid in the coronal plane. These measurements can be used as surgical guides to reduce the risk of arterial injury during olecranon fracture surgery.
Collapse
|
5
|
Abstract
Olecranon fractures are common upper extremity injuries. The vast majority are treated with operative fixation. Many treatment techniques have been described including tension band and plating. This review covers the most commonly used fixation techniques in detail, including pearls and pitfalls with case examples of both successful treatments and potential complications.
Collapse
|
6
|
Karthik K, Tahmassebi R, Tavakkolizadeh A, Compson J. Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture. Strategies Trauma Limb Reconstr 2014; 9:121-5. [PMID: 25063222 PMCID: PMC4122682 DOI: 10.1007/s11751-014-0197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022] Open
Abstract
A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30° on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6 months, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis.
Collapse
Affiliation(s)
- Karuppaiah Karthik
- Upper Limb Unit, Department of Orthopaedic Surgery, King's College Hospital, Denmark Hill, London, SE59RS, UK,
| | | | | | | |
Collapse
|
7
|
|
8
|
Molony DC, Kennedy J, Gheiti A, Mullett JH. Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: a comparative study. Injury 2011; 42:343-6. [PMID: 20356591 DOI: 10.1016/j.injury.2010.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/20/2010] [Accepted: 02/26/2010] [Indexed: 02/02/2023]
Abstract
The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal. We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method. We found the distance from the centre of the medullary canal, the range and standard deviations of K-wire positions to be significantly more precise when the jig was used. This has applications for the use of the device, both with standard metallic radio-opaque wires and potentially with bio-absorbable pins.
Collapse
Affiliation(s)
- Diarmuid C Molony
- Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland.
| | | | | | | |
Collapse
|
9
|
Sadri H, Stern R, Singh M, Linke B, Hoffmeyer P, Schwieger K. Transverse fractures of the olecranon: a biomechanical comparison of three fixation techniques. Arch Orthop Trauma Surg 2011; 131:131-8. [PMID: 20680308 DOI: 10.1007/s00402-010-1156-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The gold standard for treating transverse olecranon fractures is tension band fixation. A problem with this technique is migration of the K-wires leading to premature hardware removal. The aim of this study is to compare stability provided by two new techniques designed to eliminate the problem with backing out of K-wires, with that of the recommended tension band technique, performed with a biomechanical in vitro investigation. Our hypothesis was that the two new techniques would provide at least equal stability as the traditional tension band fixation. METHODS Transverse olecranon osteotomies were created in human cadaveric elbows to simulate a type 21-B1.1 fracture. Three groups of 8 specimens were instrumented with: (1) recommended AO tension band technique; (2) modified K-wires with eyelets and tension band; (3) staples across the fracture with tension band. Each elbow was tested in a 90° flexed position. The triceps tendon was sinusoidally loaded by applying two load steps at 500 and 700 N for 4000 cycles each. Relative movements between the fragments were determined. RESULTS At the end of the first and second load step the displacement of the osteotomy at the posterior ulnar side was significantly less for the staples across the fracture with tension band as compared to both other groups. There were no significant differences between groups 1 and 2. CONCLUSION Since clinical results depend partly on stable fixation, it is concluded that using staples in the clinical situation might provide better results than the currently recommended tension band technique.
Collapse
Affiliation(s)
- Hassan Sadri
- University Hospital Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
| | | | | | | | | | | |
Collapse
|
10
|
Comminuted proximal Ulna fractures: injury pattern surgical techniques and outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2010. [DOI: 10.1007/s00590-010-0614-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
11
|
De Carli P, Gallucci GL, Donndorff AG, Boretto JG, Alfie VA. Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: a case report. J Shoulder Elbow Surg 2009; 18:e40-4. [PMID: 19393921 DOI: 10.1016/j.jse.2009.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 02/04/2009] [Accepted: 02/07/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Pablo De Carli
- Department of Hand and Upper Extremity Surgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | |
Collapse
|
12
|
|