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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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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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Zhang D, Blazar P, Earp BE. Factors Associated With 30-Day Morbidity and Mortality Following the Surgical Treatment of Olecranon Fractures. Orthopedics 2023; 46:e310-e316. [PMID: 36921223 DOI: 10.3928/01477447-20230310-05] [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] [Indexed: 03/18/2023]
Abstract
The objective of this study was to identify factors independently associated with complications, hospital readmission, reoperation, and death in the 30-day period after surgical treatment of isolated olecranon fractures. A retrospective case-control study was performed using the National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for patients who underwent surgical treatment of isolated olecranon fractures from 2011 to 2020. A total of 4404 patients were included. The main study outcomes were 30-day medical or wound complications, hospital readmission, reoperation, and death. A bivariate screen was performed for explanatory variables associated with our outcome variables, and variables with P<.1 in the bivariate screen were included in multivariable regression models. Of the 4404 patients in our cohort, 29 patients (0.7%) developed medical or wound complications, 157 patients (3.6%) were readmitted, 123 patients (2.8%) underwent reoperation, and 12 patients (0.3%) died during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, smoking, bleeding disorders, and higher American Society of Anesthesiologists classification were associated with readmission; that older age, bleeding disorders, and higher American Society of Anesthesiologists classification were associated with reoperation; and that bleeding disorders were associated with mortality. No identifiable factors were independently associated with medical or wound complications. In this National Surgical Quality Improvement Program database study of olecranon fractures treated surgically during a recent 10-year period, we identified demographic and comorbid factors independently associated with 30-day postoperative readmission, reoperation, and mortality. Our findings are relevant for preoperative risk stratification and counseling. [Orthopedics. 2023;46(5):e310-e316.].
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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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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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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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7
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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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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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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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Oliver WM, Searle HKC, Molyneux SG, White TO, Clement ND, Duckworth AD. Factors Associated with Patient-Reported Outcomes Following a Humeral Shaft Fracture: Nonunion Results in a Poorer Outcome Despite Union after Surgical Fixation. J Orthop Trauma 2022; 36:e227-e235. [PMID: 34999623 DOI: 10.1097/bot.0000000000002315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The primary aim was to assess patient-reported outcomes ≥1 year following a humeral diaphyseal fracture. The secondary aim was to compare outcomes of patients who united after initial management (operative/nonoperative) with those who united after nonunion fixation (NU-ORIF). DESIGN Retrospective. SETTING University teaching hospital. PATIENTS AND INTERVENTION From 2008 to 2017, 291 patients [mean age, 55 years (17-86 years), 58% (n = 168/291) female] were available to complete an outcomes survey. Sixty-four (22%) were initially managed operatively and 227 (78%) nonoperatively. After initial management, 227 (78%) united (n = 62 operative, n = 165 nonoperative), 2 had a delayed union (both nonoperative), and 62 (21%) had a nonunion (n = 2 operative, n = 60 nonoperative). Fifty-two patients (93%, n = 52/56) united after NU-ORIF. MAIN OUTCOME MEASURES QuickDASH, EuroQol-5 Dimension (EQ-5D)/EuroQol-Visual Analogue Scale (EQ-VAS), 12-item Short Form Physical (PCS) and Mental Component Summary (MCS). RESULTS At a mean of 5.5 years (range, 1.2-11.0 years) postinjury, the mean QuickDASH was 20.8, EQ-5D was 0.730, EQ-VAS was 74, PCS was 44.8 and MCS was 50.2. Patients who united after NU-ORIF reported worse function (QuickDASH, 27.9 vs. 17.6; P = 0.003) and health-related quality of life (HRQoL; EQ-5D, 0.639 vs. 0.766; P = 0.008; EQ-VAS, 66 vs. 76; P = 0.036; PCS, 41.8 vs. 46.1; P = 0.036) than those who united primarily. Adjusting for confounders, union after NU-ORIF was independently associated with a poorer QuickDASH (difference, 8.1; P = 0.019) and EQ-5D (difference, -0.102; P = 0.028). CONCLUSIONS Humeral diaphyseal union after NU-ORIF resulted in poorer patient-reported outcomes compared with union after initial management. Targeting early operative intervention to at-risk patients may mitigate the potential impact of nonunion on longer-term outcome. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- William M Oliver
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
| | - Henry K C Searle
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
| | - Samuel G Molyneux
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
| | - Timothy O White
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
| | - Nicholas D Clement
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Trauma, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom ; and
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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11
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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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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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Nolte PC, Midtgaard K, Miles JW, Tanghe KK, Provencher MT. The Effect of Buttress Plating on Biomechanical Stability of Coronal Shear Fractures of the Capitellum: A Cadaveric Study. J Hand Surg Am 2022:S0363-5023(21)00801-7. [PMID: 35153076 DOI: 10.1016/j.jhsa.2021.12.007] [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: 03/03/2021] [Revised: 10/21/2021] [Accepted: 12/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare, using a cadaveric model, the biomechanical properties of headless compression screws (HCSs) and HCSs augmented with a buttress plate (BP) in capitellar fractures. METHODS Twenty pairs of fresh-frozen humeri (mean age, 46.3 years; range, 33-58 years) were used. The soft tissue was removed, and a Dubberley type IA capitellar fracture was created. One specimen in each pair was randomly assigned to receive either two 2.5-mm HCSs (HCS group) or two 2.5-mm HCSs augmented with an anterior 2.4-mm BP (HCS + BP group). This resulted in a similar distribution of the left and right humeri between the groups. Cyclic loading was performed, and displacement of the capitellum at 50, 100, 250, 500, 1,000, and 2,000 cycles was assessed using a motion capture system. This was followed by load-to-failure testing, wherein the load at a displacement of 1 and 2 mm was recorded. Failure was defined as 2-mm displacement. RESULTS During cyclic loading, there were no significant differences in the displacement between the HCS and HCS + BP groups at any of the assessed cycles. During load-to-failure testing, no significant strength differences were observed in the load at 1-mm displacement between the HCS (mean: 449.8 N, 95% CI: 283.6-616.0) and HCS + BP groups (mean: 606.2 N, 95% CI: 476.4-736.0). However, a significantly smaller load resulted in a 2-mm displacement of the fragment in the HCS group (mean: 668.8 N, 95% CI: 414.3-923.2) compared with the HCS + BP group (mean: 977.5 N, 95% CI: 794.1-1,161.0). CONCLUSIONS Anterior, low-profile buttress plating in addition to HCSs results in a significantly higher load to failure compared with HCSs alone in a biomechanical Dubberley type IA capitellar fracture model. CLINICAL RELEVANCE The addition of an anterior BP may be considered to improve initial stability in select cases such as osteoporotic patients or when the posterolateral column is frail.
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Affiliation(s)
- Philip C Nolte
- Steadman Philippon Research Institute, Vail, Colorado; BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwigshafen, Germany
| | - Kaare Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Norwegian Armed Forces Joint Medical Services, Forsvarsvegen, Norway
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado
| | - Kira K Tanghe
- Steadman Philippon Research Institute, Vail, Colorado
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado; Steadman Clinic, Vail, Colorado.
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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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Intramedullary Screw Fixation of Olecranon Fractures Reduces the Risk of Early Unplanned Reoperation: A Retrospective Review of 556 Patients. J Orthop Trauma 2022; 36:e24-e29. [PMID: 33878072 DOI: 10.1097/bot.0000000000002145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the effect of intramedullary screw-based fixation on early postoperative complications after olecranon fractures. We hypothesized that intramedullary screw-based fixation results in decreased need for reoperation compared with plate and screw-based and tension band-based fixation. DESIGN Retrospective cohort. SETTING Two academic Level-1 trauma centers. PATIENTS/PARTICIPANTS Five hundred fifty-six patients treated with a tension band-based, plate and screw-based, or intramedullary screw-based construct for an olecranon fracture over a 10-year period. INTERVENTION Open reduction and internal fixation. MAIN OUTCOME MEASUREMENT Unplanned reoperation. Demographic, injury type and severity, supplemental fixation, and length of follow-up data were viewed as potential confounders and analyzed as such. RESULTS We identified 556 relevant patients. One hundred ninety-nine patients were treated with an intramedullary screw-based construct, 229 with a plate and screw-based construct, and 128 with a tension band-based construct. We observed significant differences in the age, fracture type, percentage of open fractures, use of supplemental fixation, and treating institution between the treatment groups. Ninety-five patients (17.1%) had an unplanned reoperation. When we adjusted for confounders, intramedullary screw-based fixation reduced the odds of an unplanned reoperation by 54% compared with plate and screw-based treatment. In the adjusted analysis, we did not observe a difference between plate and screw-based treatment and tension band-based fixation. CONCLUSIONS Intramedullary screw-based fixation of olecranon fractures results in decreased need for early reoperation compared with more common olecranon fixation strategies. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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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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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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Tsujino S, Tsujino A, Matsubara M. Tension-band wiring of displaced stable olecranon fractures with Eyelet-pins in the elderly: A series of 17 cases. Orthop Traumatol Surg Res 2021; 107:103076. [PMID: 34563734 DOI: 10.1016/j.otsr.2021.103076] [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: 02/09/2021] [Revised: 05/16/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tension-band wiring (TBW) and plate fixation are commonly used to fix displaced olecranon fractures. However, the high incidence of complications in the elderly, such as wound breakdown, infection, and loss of reduction, remain a concern for orthopaedic surgeons. Furthermore, patients frequently suffer from removal of the hardware. Even so, the operation seems to be indicated for independent elderly patients to return to their former activities of daily living. HYPOTHESIS TBW of displaced stable olecranon fractures with Eyelet-pins in the independent elderly reduce the incidence of complications and allow early elbow joint exercise to keep their former activities. PATIENTS AND METHODS We operated on the displaced stable olecranon fractures of 17 independent patients aged ≥ 70 using TBW with two Eyelet-pins. Eyelet-pins have an eyelet at the trailing end to prevent pin migration by passing a soft wire through it. The patients were reviewed clinically and radiologically at 2, 6, 12, and 24 weeks, and clinically at 1 year after the surgery. RESULTS All fractures were united within 12 weeks, and the anatomic reduction was maintained. Mean radiographic proximal migration of the Eyelet-pins was 0.4mm (0.1 ∼ 1.2mm). Mean active elbow flexion was 136° (115° ∼ 145°) and extension 6.2° (0° ∼ 30°). Two patients had mild local pain and pain on motion at the tip of the eyelet. No patient required removal of the hardware. Other complications, such as superficial or deep wound infections, and neurological symptoms or signs, were not seen. All patients were able to maintain their former activities of daily living. CONCLUSION TBW with Eyelet-pins for displaced stable olecranon fractures is useful for independent elderly patients to reduce the incidence of complications and to maintain their former activities of daily living without removal of the hardware. LEVEL OF EVIDENCE IV; single-centre retrospective study.
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Affiliation(s)
- Shohei Tsujino
- Department of Orthopaedic Surgery, Tamagawa Hospital, Setagaya, Tokyo, Japan; Miraidaira Orthopaedic Clinic, Tsukubamirai, Japan.
| | | | - Masaaki Matsubara
- Department of Orthopaedic Surgery, Tamagawa Hospital, Setagaya, Tokyo, Japan
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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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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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Phadnis J, Eves T, Watts AC. Tension Suture Fixation of Olecranon Fractures. JBJS Essent Surg Tech 2021; 11:ST-D-20-00042. [PMID: 34277131 DOI: 10.2106/jbjs.st.20.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Mayo type-IIA olecranon fractures are characterized by a transverse or short oblique fracture without articular comminution or ulnohumeral instability. Traditionally, these fractures are treated with a tension-band wiring technique. Despite good rates of fracture union, tension-band wiring is associated with a reoperation rate of 30% to 60%, usually for removal of prominent metalwork. The tension suture technique was developed as an alternative method of fixing Mayo type-IIA fractures using only high-tensile braided nonabsorbable number-2 sutures, with the aim of reducing the reoperation rate associated with tension-band wiring without compromising outcomes. The tension suture technique has subsequently become the only technique we use when treating these fractures. Description The patient is positioned in the lateral decubitus position under general or regional anesthesia. A direct posterior approach is made, centered over the fracture. The fracture is identified, cleared of hematoma, and reduced with use of a large, pointed reduction clamp to provide interfragmentary compression. A 2.5-mm transverse drill hole is made through the ulna distal to the fracture site. Two sets of number-2 braided nonabsorbable sutures are utilized. The first sutures are passed lateral to medial through the drill hole and used to grasp the medial triceps insertion onto the proximal fragment, then passed back through the transverse drill hole from medial to lateral and used to grasp the lateral triceps insertion onto the proximal fragment. The suture ends are tensioned to remove slack and tied on the lateral aspect of the olecranon. The second sutures are then passed lateral to medial through the transverse drill hole but this time used to grasp the posterolateral triceps insertion on the proximal fragment, then re-passed through the transverse drill hole from medial to lateral, and finally used to grasp the posteromedial triceps insertion. The suture limbs are tensioned and tied on the lateral aspect of the ulna next to the first suture. The clamp is removed, and the construct is tested under full range of motion to ensure there is no evidence of gapping. Fluoroscopy is utilized to confirm reduction before the wound is irrigated and closed in a standard fashion. Alternatives Mayo type-IIA fractures may be treated nonoperatively in frail or low-demand patients. Surgical treatment is traditionally performed with the tension-band wiring technique, but plate or intramedullary fixation may also be utilized. Rationale This technique negates the metalwork-related complications associated with all other surgical techniques for this fracture type. Expected Outcomes In a recent study comparing the tension suture technique with tension-band wiring and plate fixation for Mayo type-IIA fractures, the tension suture technique had a significantly lower reoperation rate compared with tension-band wiring and a lower complication rate compared with plate fixation. Important Tips The tension-suture technique is primarily for Mayo type-IIA fractures without ulnohumeral instability or marked articular comminution.Ensure the transverse tunnel in the ulna is at least 3 cm distal to the fracture site and 1 cm anterior to the dorsal cortex of the ulna in order to prevent fracture of the tunnel.Grasp as much of the triceps tendon as possible when placing the sutures through the proximal fragment to prevent pull-out.Tension and tie the sutures with the elbow semi-extended to prevent the construct slackening in elbow extension and to facilitate interfragmentary compression during flexion.
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Affiliation(s)
- Joideep Phadnis
- Brighton & Sussex University Hospitals, Brighton, United Kingdom.,Brighton & Sussex Medical School, Brighton, United Kingdom
| | - Timothy Eves
- Brighton & Sussex University Hospitals, Brighton, United Kingdom
| | - Adam C Watts
- Wrightington Upper Limb Unit, Wigan, United Kingdom.,Manchester University, Manchester, United Kingdom
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Wise KL, Peck S, Smith L, Myeroff C. Locked plating of geriatric olecranon fractures leads to low fixation failure and acceptable complication rates. JSES Int 2021; 5:809-815. [PMID: 34223435 PMCID: PMC8245976 DOI: 10.1016/j.jseint.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypothesis The purpose of this study was to report the rate of major complications in patients with geriatric olecranon fractures managed operatively with a locking plate. Secondary objectives included minor complications, as well as pain and range of motion at the final follow-up. We hypothesized that these patients have a low rate of complications as well as low pain and satisfactory elbow range of motion at the final follow-up. Materials and Methods A retrospective review of isolated geriatric olecranon fractures presenting from 2006 to 2019 was performed at a single level I trauma center. Inclusion criteria were ≥75 years of age, operative management with a locking plate, and clinic follow-up at least until evidence of radiographic union or a major complication. Exclusion criteria included nonoperative management, insufficient follow-up, and absence of locking plate in surgical technique. Variables examined included demographic information, Charleston comorbidity index, American Society of Anesthesiologists score, living independence, gait assistance, mechanism of injury, open vs. closed fracture, Mayo radiographic classification, Arbeitsgemeinschaft für Osteosynthesefragen classification, time to surgery, implant type, presence of triceps offloading suture, length of postoperative immobilization, date of radiographic union, range of motion at the final follow-up, pain visual analog scale score at the final follow-up, major and minor complications, and return to the operative room. A major complication was defined as a return to the operative room for deep infection or loss of fixation (displacement of fracture >5 mm). A minor complication was defined as any other complication. Results A total of 65 patients ≥75 years of age with olecranon fractures were identified. Of these, 36 patients met inclusion criteria with an average follow-up of 23 weeks (range 5-207). The mean length of immobilization was 13 days (range 0-29 days). Thirty-two of 36 (88.8%) patients achieved radiographic evidence of union at an average of 8.9 weeks (range 5.3-24.1 weeks). There were 4 remaining patients who underwent secondary intervention before primary union representing an 11.1% major complication rate including 2 deep infections (5.6%) and 3 failures of fixation (8.3%). There were 7 minor complications in 5 of 36 (13.9%) patients. At the final follow-up, the average visual analog scale score was 2.6 (range 0-6), the average elbow arc of motion was 120° (range 70-147°), and mean pronation/supination was 85°/84° (range 45-90°/45-90°). Conclusion Geriatric olecranon fractures are a challenging orthopedic problem with remaining controversy regarding ideal treatment. Despite advancement in geriatric fracture care, there is scant literature on the outcomes of locked plating technology in geriatric olecranon fractures. This study supports use of operative anatomic fixation with precontoured locked plates and early mobilization with an acceptable failure rate.
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Affiliation(s)
- Kelsey L. Wise
- University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, USA
| | - Sarah Peck
- Regions Hospital Department of Orthopedic Surgery, Saint Paul, MN, USA
| | - Lauren Smith
- University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, USA
| | - Chad Myeroff
- University of Minnesota Department of Orthopaedic Surgery, Minneapolis, MN, USA
- Regions Hospital Department of Orthopedic Surgery, Saint Paul, MN, USA
- TRIA Orthopedic Center, Woodbury, MN, USA
- Corresponding author: Chad Myeroff, MD, Mail Stop 11503L, 640 Jackson Street, St Paul, MN, 55101-2595, USA.
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Contreras Fernández JJ, Beltrán M, Córdova C, Benavente S, Díaz C, Rojas N, Vial S, Díaz A, Otero E, Palomo H, Liendo R, Soza F. Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:26-33. [PMID: 37588634 PMCID: PMC10426501 DOI: 10.1016/j.xrrt.2020.11.004] [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 Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. Methods We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Results Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5° ± 14.8° (range, 70°-140°) and the mean extension was -5.9° ± 7.0° (range, -20°-0°). Mean pronation and supination were 85.8° ± 11.9° (range, 45°-90°) and 86.9° ± 14.3° (range, 20°-90°), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P = 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P = 0.05), articular angle (22.5° vs. 27.7°, P = 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P = 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7° vs. 6.4°, P = 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P = 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P = 0.0219). Conclusion The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.
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Affiliation(s)
- Julio J. Contreras Fernández
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Manuel Beltrán
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Carlos Córdova
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Sergio Benavente
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
| | - Cristóbal Díaz
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Nicolás Rojas
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Sebastián Vial
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Alonso Díaz
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Eduardo Otero
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Héctor Palomo
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
| | - Rodrigo Liendo
- Shoulder and Elbow Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Soza
- Shoulder and Elbow Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abdelmalek A, Crowther M. Olecranon fractures in the elderly during the COVID-19 pandemic: Is non-operative treatment reasonable? Review of the current evidence. Musculoskelet Surg 2021; 105:125-130. [PMID: 33511549 PMCID: PMC7843878 DOI: 10.1007/s12306-021-00699-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022]
Abstract
The current COVID-19 global pandemic presents a major challenge and unprecedented pressures on health systems. The national guidelines in the UK advise non-operative treatment of fractures whenever possible to reduce the risk of surgical intervention to both patient and healthcare staff. The elderly population over 70 years are highlighted as a high-risk group in this pandemic as well as being often high risk for surgery in general due to co-morbidities. This article reviews the current literature regarding treatment of displaced olecranon fractures in the elderly. Literature search of the available databases. One randomised controlled trial has been published, comparing operative versus non-operative treatments of olecranon fractures in this age group. The study was terminated prematurely due to the high complication rate in the operative group. No difference in functional scores was recorded. Other published retrospective case series report good functional outcome scores and high satisfaction rates in the majority of patients in whom olecranon fractures were treated non-operatively. Non-operative treatment of olecranon fractures in elderly patients seems to be safe and an acceptable management option in these unprecedented times.
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Affiliation(s)
| | - Mark Crowther
- Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
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29
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Aibinder WR, Sims LA, Athwal GS, King GJW, Faber KJ. Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients. JSES Int 2021; 5:291-295. [PMID: 33681852 PMCID: PMC7910720 DOI: 10.1016/j.jseint.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients. Methods A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months. The mean age at the time of injury was 79 ± 10 years. The average Charlson Comorbidity Index was 6.4 ± 2.6. Treatment modalities were at the discretion of the treating surgeon. A sling alone was used in 3 cases, an extension circumferential cast in 9, or a plaster or thermoplastic splint in 16. The mean period of immobilization was 5 ± 1 weeks. Outcomes included range of motion, ability to perform active overhead extension, as well as radiographic and functional outcomes. Results At final follow-up, the mean elbow range of motion for the cohort was from 28° ± 21° extension to 127° ± 15° flexion. Active overhead elbow extension against gravity was noted or documented in 24 (86%) patients. Two patients (7%) were unable to perform active extension. No pain was noted in 18 elbows, severe pain was present in 1 elbow, and the remainder reported mild occasional pain. All olecranon fractures in this cohort were displaced on the initial lateral radiograph. The mean displacement was 11 ± 7 mm. Nonunion at final radiographic outcome was observed in 23 (82%) elbows. Two (7%) patients developed skin complications related to posteriorly placed splints; one of which was severe. Discussion This study adds to the growing literature that supports nonoperative management of displaced olecranon fractures in elderly and medically unwell patients with low upper extremity demand. Patients can be counseled that they have a good chance of obtaining overhead extension, with minimal pain. Posteriorly based splints should not be used to minimize skin complications.
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Affiliation(s)
- William R Aibinder
- Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Laura A Sims
- Department of Orthopedics, University of Saskatchewan, Saskatoon, SK, Canada
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Roth McFarlane Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada
| | - Kenneth J Faber
- Roth McFarlane Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada
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Surgical and Nonoperative Management of Olecranon Fractures in the Elderly: A Systematic Review and Meta-Analysis. J Orthop Trauma 2021; 35:10-16. [PMID: 32569071 DOI: 10.1097/bot.0000000000001865] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this comparative effectiveness study was to perform a meta-analysis of adverse events and outcomes in closed geriatric olecranon fractures, without elbow instability, after treatment with surgical or nonoperative management. DATA SOURCES PubMed, Web of Science, and Embase databases. STUDY SELECTION Articles were included if they contained clinical data evaluating outcomes in patients ≥65 years of age with closed olecranon fractures, without elbow instability, treated surgically, or with nonoperative management. DATA EXTRACTION Data regarding patient age, olecranon fracture type, fracture union, adverse events, reoperation, elbow range of motion, and surgeon and patient reported outcome measures were recorded according to intervention. The interventions included for analysis were tension band wire fixation, plate fixation, or nonoperative management. DATA SYNTHESIS Separate random effects meta-analyses were conducted for each outcome according to intervention. Prevalence and 95% confidence intervals were calculated for dichotomous variables, whereas weighted means and confidence intervals were calculated for continuous variables. CONCLUSIONS Comparable outcomes were achieved with surgical or nonoperative management of olecranon fractures in geriatric patients. Surgical intervention carried a high risk of reoperation regardless of whether plate or tension band wire fixation was used. Functional nonunion can be anticipated if nonoperative treatment is elected in low-demand elderly patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Phadnis JS, Vaughan A, Luokkala T, Peters J, Watson JJ, Watts A. Comparison of all suture fixation with tension band wiring and plate fixation of the olecranon. Shoulder Elbow 2020; 12:414-421. [PMID: 33281946 PMCID: PMC7689611 DOI: 10.1177/1758573219831662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/25/2018] [Accepted: 01/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Tension band wiring and plate fixation are common techniques used to stabilize simple olecranon fractures and osteotomies of the olecranon. All suture fixation is an alternative technique but has not been compared previously to these traditional methods. The aim of this study was to compare the clinical and radiographic outcomes of the three techniques. METHODS One hundred and sixty-eight consecutive Mayo type 1 and 2 olecranon fractures (n = 138) and olecranon osteotomies (n = 30) with a minimum follow-up time of one year were compared. The primary outcome measure was the rate of re-operation. Secondary outcome measures were the incidence of complications, rate of radiographic union and incidence of radiographic reduction loss. RESULTS Fixation was performed using tension band wiring in 89 patients, plating in 38 patients and suture fixation in 41 patients. There was no significant difference in the fracture type according to the Mayo classification between the groups. The re-operation rate was significantly higher in the tension band wiring group (36%) compared with both the plate group (11%, p = 0.03) and the suture group (2%, p = 0.002). There were two revision fixations in the tension band wiring group and one in the suture group. There was one asymptomatic non-union in the suture group. All other fractures and osteotomies achieved radiographic union. CONCLUSION Suture fixation of simple olecranon fractures and osteotomies was reliable in providing stable union and had a significantly lower re-operation rate when compared with tension band wiring.
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Affiliation(s)
- Joideep Sunil Phadnis
- Trauma & Orthopaedics, Brighton & Sussex University Hospitals, Brighton, UK,Joideep Sunil Phadnis, Consultant Shoulder & Elbow Surgeon, Brighton & Sussex University Hospitals, Brighton, UK.
| | - Alex Vaughan
- Trauma & Orthopaedics, Brighton & Sussex University Hospitals, Brighton, UK
| | | | - Jonathon Peters
- Trauma & Orthopaedics, Brighton & Sussex University Hospitals, Brighton, UK
| | - Jay J Watson
- Trauma & Orthopaedics, Brighton & Sussex University Hospitals, Brighton, UK
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Crozier-Shaw G, Mahon J, Bayer TC. The use of bioabsorbable compression screws & polyethylene tension band for fixation of displaced olecranon fractures. J Orthop 2020; 22:525-529. [PMID: 33132626 PMCID: PMC7588653 DOI: 10.1016/j.jor.2020.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Transverse fractures of the olecranon are commonly fixed using tension-band wiring techniques. However the superficial nature of this area leads to high complication rates requiring removal of metalwork. The purpose of this retrospective study is to report and evaluate functional outcomes of polyethylene tension-band and bioabsorbable Magnesium alloy screw fixation of olecranon fractures. METHODS A retrospective case-control study was undertaken. Demographics, injury type and post-operative details were collected. All patients were treated in the same institution by a single surgeon. Primary outcomes included radiographic healing and post-operative range of motion. Secondary outcome was post-operative complications. RESULTS A total of five cases were identified. Mean age was 52.4. The control group was made up of six patients treated with a traditional tension band wire fixation. One patient in study group was lost to follow up. 80% of fractures in study group demonstrated anatomic post-operative radiographic union, compared with 83% of control group. All patients had range of motion above 100°, with full protonation and supination. One patient did have an extension lag of 15°. CONCLUSION Surgical repair of olecranon fractures is often complicated by the need for re-operation. This method provides both intramedullary fixation and conversion of distraction forces to compression forces with bioabsorbable materials, and aims to reduce the high re-operation rates commonly seen by avoiding the use of permanent indwelling metal hardware.
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Affiliation(s)
- Geoff Crozier-Shaw
- Department of Trauma and Orthopaedic Surgery, Midland Regional Hospital Tullamore, Co Offaly, Ireland
| | - John Mahon
- Department of Trauma and Orthopaedic Surgery, Midland Regional Hospital Tullamore, Co Offaly, Ireland
| | - Thomas C. Bayer
- Department of Trauma and Orthopaedic Surgery, Midland Regional Hospital Tullamore, Co Offaly, Ireland
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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
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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
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Oitment C, Koziarz A, Bozzo A, Johal H. Intramedullary Cancellous Screw Fixation of Simple Olecranon Fractures. Strategies Trauma Limb Reconstr 2020; 14:163-167. [PMID: 32742433 PMCID: PMC7368355 DOI: 10.5005/jp-journals-10080-1435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Olecranon fractures and osteotomies are treated with either tension-band wiring or plate-screw fixation; however, these methods of fixation have high rates of symptomatic hardware, resulting in revision surgery. We describe the novel use of intramedullary noncannulated long screws to gain rigid internal fixation and allow early range of motion. Our procedure differs from traditional intramedullary olecranon fixation as the longer screws, which can commonly be found on many pelvic fixation sets, allow for endosteal purchase at the isthmus of the ulna, which increases the pull-out strength of the screw. This procedure can be done quickly and requires minimal exposure, which minimises anaesthetic exposure, blood loss, and tourniquet time. The construct is not palpable subcutaneously and therefore is less likely to result in symptomatic hardware and revision surgery.
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Affiliation(s)
- Colby Oitment
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex Koziarz
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anthony Bozzo
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Abstract
The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments. Advanced imaging, improved understanding of the complex anatomy of the elbow joint, and improved fixation techniques have contributed to improved elbow fracture outcomes.
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Affiliation(s)
- Kaare S Midtgaard
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA; Oslo University Hospital, Division of Orthopaedic Surgery, Kirkeveien 166, Oslo 0450, Norway; Norwegian Armed Forces Joint Medical Services, Forsvarsvegen 75, Sessvollmoen 2058, Norway
| | - Joseph J Ruzbarsky
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Thomas R Hackett
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Randall W Viola
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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Abstract
Aims The aim of this study is to report the results of a case series of olecranon fractures and olecranon osteotomies treated with two bicortical screws. Methods Data was collected retrospectively for all olecranon fractures and osteotomies fixed with two bicortical screws between January 2008 and December 2019 at our institution. The following outcome measures were assessed; re-operation, complications, radiological loss of reduction, and elbow range of flexion-extension. Results Bicortical screw fixation was used to treat 17 olecranon fractures and ten osteotomies. The mean age of patients being treated for olecranon fracture and osteotomy were 48.6 years and 52.7 years respectively. Overall, 18% of olecranon fractures were classified as Mayo type I, 71% type II, and 12% type III. No cases of fracture or osteotomy required operative re-intervention. There were two cases of loss of fracture reduction which occurred in female patients ≥ 75 years of age with osteoporotic bone. In both cases, active extension and a functional range of movement was maintained and so the loss of reduction was managed non-operatively. For the fracture fixation cohort, at final follow-up mean elbow extension and flexion were -5° ± 5° and 136° ± 7°, with a mean arc of motion of 131° ± 11°. Conclusion This series has shown that patients regain near full range of elbow flexion-extension and complication rates are low following bicortical screw fixation of olecranon fractures and osteotomy. Cite this article: Bone Joint Open 2020;1-7:376–382.
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Affiliation(s)
- James R Gill
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Lieven Vermuyten
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Sophie A Schenk
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Josh C Y Ong
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - Willem Schenk
- Department of Trauma and Orthopaedics, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
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Bugarinovic G, McFarlane KH, Benavent KA, Janssen SJ, Blazar PE, Earp BE. Risk Factors for Hardware-Related Complications After Olecranon Fracture Fixation. Orthopedics 2020; 43:141-146. [PMID: 32191948 DOI: 10.3928/01477447-20200314-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate risk factors for symptomatic hardware and removal of hardware (ROH) after olecranon open reduction and internal fixation (ORIF) and to assess differences between olecranon locking plate and screws (P&S) or tension band (TB) wire cohorts. The medical records of 331 patients with olecranon fractures treated at two academic level I trauma centers with ORIF from 2012 to 2016 were reviewed. A total of 189 patients were included in the study. Complications, ROH, and subsequent surgery were assessed and compared between cohorts. There were 124 cases in the P&S cohort and 65 in the TB cohort. The overall reoperation rate was 31.2% (59 of 189). The overall incidence of ROH for all cases was 29.1% (55 of 189). Patients who required ROH or developed symptomatic hardware were significantly younger than those who did not (P&S, P<.003; TB, P<.004). Age and body mass index (BMI) were associated with ROH plus symptomatic hardware after P&S. Age (but not BMI) was associated with ROH/symptomatic hardware after TB. Measured hardware prominence was not associated with ROH or ROH plus symptomatic hardware for either the P&S or the TB cohort. Risk factors including patient age and BMI were found to be significantly associated with hardware-related complications. [Orthopedics. 2020;43(3):141-146.].
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Rantalaiho IK, Miikkulainen AE, Laaksonen IE, Äärimaa VO, Laimi KA. Treatment of Displaced Olecranon Fractures: A Systematic Review. Scand J Surg 2019; 110:13-21. [PMID: 31822216 DOI: 10.1177/1457496919893599] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The incidence of olecranon fractures is rising. Displaced fractures are usually operated either by tension band wiring or plate fixation. The aim of this review is to evaluate the best current evidence on the management of displaced olecranon fractures. MATERIALS AND METHODS Randomized controlled trials were systematically gathered in May 2018 from CENTRAL, MEDLINE, Embase, CINAHL, Scopus, and PEDro databases. The methodological quality of articles was assessed according to the Cochrane Collaboration's domain-based framework. Prospero database registration number: CRD42018096650. RESULTS Of 1518 identified records, finally, 5 were relevant. Four trials were found on tension band wiring: two compared tension band wiring with plate fixation (n = 108), one compared plate fixation with an olecranon memory connector (n = 40), and one trial compared tension band wiring with a modified tension band wiring called Cable Pin System (n = 62). In addition, one trial compared operative and conservative treatment in elderly (n = 19). The risk of bias was considered low in two and high in three of the trials. The follow-up time was 5-36 months, and outcome measures varied from patient-rated and physician-rated measures to radiological outcomes. In the analysis, there was no difference between tension band wiring and plate fixation. The data were insufficient for further quantitative analysis. CONCLUSION No differences were found in clinical or patient-rated outcome measures between the two most frequent fixation methods (tension band wiring and plate fixation) of displaced olecranon fractures. Current data are not sufficient to evaluate other treatment methods; however, conservative treatment might serve as an option for selected patients in the elderly population.
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Affiliation(s)
- I K Rantalaiho
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - A E Miikkulainen
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - I E Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - V O Äärimaa
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - K A Laimi
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Geriatric olecranon fractures treated with plate fixation have low complication rates. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES To determine if mean ultimate strength or failure mechanism differed between comminuted olecranon fractures created at the proximal 25% or 50% of the trochlear notch and fixed with precontoured posterior locking plates (PLPs). METHODS Comminuted osteotomies were created in 10 matched pairs of cadaveric upper extremities at either the proximal 25% or 50% of the trochlear notch after quantitative computed tomography scans were performed to evaluate bone mineral density. Variable-angle olecranon PLPs were fixed to the specimens. The triceps tendon of each specimen was loaded cyclically and then to failure. Comparison of mean force at failure (displacement >2 mm) was performed using the 2-tailed t test. RESULTS There were no significant differences in specimen bone mineral density within matched pairs. Nineteen specimens failed by olecranon bisection fracture in the sagittal plane. Specimens in the 25% osteotomy group failed at lower ultimate forces of 808 N (SD ± 474 N) versus 1058 N (SD ± 480 N) in the 50% osteotomy group (P = 0.044). CONCLUSIONS The ultimate strength of comminuted olecranon fracture fixation with a PLP decreases significantly if the fracture is proximal to the midpoint of the trochlear notch. Fractures proximal to the midpoint of the trochlear notch may benefit from supplemental fixation or suture augmentation to prevent failure, particularly at force ranges higher than those experienced during active elbow range of motion.
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Chen YP, Lan YS, Hu WL, Hung YC. Nonoperative manipulative reduction with Chinese herbs for the treatment of a displaced olecranon fracture: A case report. Medicine (Baltimore) 2018; 97:e10818. [PMID: 29794769 PMCID: PMC6392946 DOI: 10.1097/md.0000000000010818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Displaced olecranon fracture is a common injury following a fall or direct trauma to the elbow. There have been no reports of patients with a displaced olecranon fracture who have only received nonoperative manipulative reduction with Chinese herbs. PATIENT CONCERNS The patient was a 64-year-old woman with a complex elbow injury that occurred in a traffic accident. The patient complained of severe, painful limitation of motion on straightening or bending. DIAGNOSES The patient was diagnosed with a displaced fracture of the left olecranon (type IIA olecranon fracture according to the Mayo classification system). INTERVENTIONS The patient underwent nonoperative manipulation with Chinese herbs. OUTCOMES The fracture was successfully reduced. After 3 to 4 months of follow-up, severe pain and disability in the elbow were improved following reduction of the left olecranon fracture in which there was no longer a displacement. LESSONS Nonoperative manipulative reduction performed by a well-trained physician with Chinese herbs may be a treatment option for displaced olecranon fractures.
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Affiliation(s)
- Yu-Pei Chen
- Department of Chinese Medicine, Tainan Hospital, Ministry of Health and Welfare
- School of Medicine
- School of Law, National Cheng Kung University, Tainan
| | - Yi-Shan Lan
- Department of Chinese Medicine, Tainan Hospital, Ministry of Health and Welfare
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine
- Kaohsiung Medical University College of Medicine
- Fooyin University College of Nursing
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and School of Traditional Chinese Medicine, Chang Gung University College of Medicine
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
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Marot V, Bayle-Iniguez X, Cavaignac E, Bonnevialle N, Mansat P, Murgier J. Results of non-operative treatment of olecranon fracture in over 75-year-olds. Orthop Traumatol Surg Res 2018; 104:79-82. [PMID: 29258962 DOI: 10.1016/j.otsr.2017.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/07/2017] [Accepted: 10/14/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgery is the gold-standard treatment of displaced olecranon fracture, but is associated with numerous complications, especially in the elderly. Functional results of non-operative treatment in this population have never been analyzed in a prospective study. STUDY HYPOTHESIS Non-operative treatment of isolated olecranon fracture with stable elbow-joint in over 75-year-olds gives functional results comparable to those of surgery as reported in the literature, with fewer complications. MATERIAL AND METHODS A prospective study analyzed functional results of non-operative treatment of isolated closed Mayo I and II olecranon fracture with stable elbow, in patients aged ≥75 years. The principal assessment criterion was functional recovery on the Mayo Elbow Performance Score (MEPS) and QuickDASH at 6 months. RESULTS Twenty-two fractures in 21 patients were included. Mean MEPS was 95.26/100 (range, 85-100), and mean QuickDASH 4.3 (range, 0-29.55). Eighteen fractures showed osteoarthritis of the olecranon. There were no cases of elbow instability. There were no complications. DISCUSSION Non-operative treatment of olecranon fracture in patients aged ≥75 years provided excellent functional results at 6 months, without associated complications. TYPE OF STUDY Single-center prospective observation cohort study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- V Marot
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - X Bayle-Iniguez
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - E Cavaignac
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - N Bonnevialle
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - P Mansat
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - J Murgier
- Département de chirurgie orthopédique et traumatologique, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
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Kennedy CA, Beaton DE. A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure. J Hand Ther 2017; 30:30-40.e2. [PMID: 27469538 DOI: 10.1016/j.jht.2016.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/18/2016] [Accepted: 06/17/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Survey. PURPOSE OF THE STUDY To elicit feedback on the clinical use and content validity of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure from frontline users of the instrument. METHODS A cross-sectional survey was administered to registered DASH users and inquired about how the DASH was being used and to identify the informational value of items of the DASH (content validity). RESULTS About 172 completed the survey. One or both of the DASH and/or QuickDASH were consistently (89.5%) being used. About 90% were using it in adults (21-65 years), and at least 70% were using it across the entire extremity, and to a lesser extent, 10% reported using it in isolated neck injuries. Most respondents (66.9%-75.8%) were using the DASH in musculoskeletal (MSK) disorders, with some applying it for other more unique or non-MSK conditions (2.5%-16.6%). All but 1 of the 30 DASH items had at least 10% endorsement as being informative, and 4 items were identified as being problematic by greater than 20%. CONCLUSIONS The DASH is being used as intended (whole extremity and MSK conditions), and in addition, it is being used in different body regions and diverse conditions. LEVEL OF EVIDENCE Not applicable (descriptive survey).
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Affiliation(s)
- Carol A Kennedy
- Institute for Work & Health, Toronto, Ontario, Canada; Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Dorcas E Beaton
- Institute for Work & Health, Toronto, Ontario, Canada; Mobility Program, Musculoskeletal Health & Outcomes Research, St. Michael's Hospital, Toronto, Ontario, Canada
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Phadnis J, Watts AC. Tension band suture fixation for olecranon fractures. Shoulder Elbow 2017; 9:299-303. [PMID: 28932288 PMCID: PMC5598818 DOI: 10.1177/1758573216687305] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
Olecranon fractures are common and often require surgical treatment when displaced. Traditional methods of stabilization using tension band wire fixation and plate fixation achieve adequate union and function but are associated with a high rate of re-operation and wound problems because of prominent metalwork. The purpose of the present article is to describe an all suture technique for fixation of simple olecranon fractures that maintains inter-fragmentary compression, provides bony union and reduces the rate of re-operation caused by prominent metalwork.
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Affiliation(s)
- Joideep Phadnis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK,Joideep Phadnis, 70 Nevill Avenue, Hove BN3 7NA, UK.
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Putnam MD, Christophersen CM, Adams JE. Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient. Shoulder Elbow 2017; 9:285-291. [PMID: 28932286 PMCID: PMC5598825 DOI: 10.1177/1758573217711889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/21/2017] [Accepted: 04/29/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND We report on the non-operative treatment of Mayo Type II olecranon fractures. METHODS Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained. RESULTS At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care. CONCLUSIONS In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.
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Affiliation(s)
- Matthew D. Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA,Matthew D. Putnam, Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454, USA.
| | | | - Julie E. Adams
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Hackl M, Mayer K, Weber M, Staat M, van Riet R, Burkhart KJ, Müller LP, Wegmann K. Plate Osteosynthesis of Proximal Ulna Fractures-A Biomechanical Micromotion Analysis. J Hand Surg Am 2017; 42:834.e1-834.e7. [PMID: 28606433 DOI: 10.1016/j.jhsa.2017.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Double plating has been promoted, in recent years, as an alternative treatment method for proximal ulna fractures. This study aimed to compare the biomechanical properties of double-plate osteosynthesis with posterior plate fixation using a novel investigational design utilizing a 3-dimensional camera system to analyze fracture micromotion. METHODS Fourteen fresh-frozen specimens were available for this study. Mayo type IIA fractures of the olecranon were created and internal fixation was performed with either an angular stable posterior plate or angular stable double plates. Fracture micromotion was evaluated by means of digital image correlation with a 3-dimensional camera system before and after dynamic cyclic loading from 15° to 90° of elbow flexion with a pulling force of 25 N to 80 N. RESULTS Micromotion of fragments was less pronounced in double-plate osteosynthesis when compared with single plates before and after cyclic loading. However, overall results were similar. Two of the single plates failed during cyclic loading but there were no failures in the double plates. CONCLUSIONS This biomechanical analysis shows that single and double plating results in comparable stability of fixation. Although the double-plating technique tends to provide more stable fixation, relevant differences were not observed. CLINICAL RELEVANCE Double plating potentially represents an efficient option for fixation of proximal ulna fractures. It could decrease the risk of soft tissue complications owing to their low profile and the superior soft tissue coverage.
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Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany; Institute of Anatomy I, University of Cologne, Cologne, Germany.
| | - Katharina Mayer
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Mareike Weber
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Manfred Staat
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Roger van Riet
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
| | | | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany
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Liñán-Padilla A, Cáceres-Sánchez L. Type II olecranon fractures in patients over 65. Tension band or pre-formed plate? Analysis and results. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation. Arch Phys Med Rehabil 2017; 98:1863-1892.e14. [DOI: 10.1016/j.apmr.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/04/2023]
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