ABSTRACT
Abstract Objective To choose an appropriate posterior approach for distal humerus fractures in adults. Methods Fifty patients with distal humerus fractures were analyzed prospectively. The fractures were classified using the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO, Working Group for Bone Fusion Issues, in German/OTA) classification. The patients were divided into group A and group B. Olecranon osteotomy (the transolecranon approach) was performed in 30 patients, and the triceps-reflecting approach was used in 20 patients. The functional results were evaluated using the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Results The average operative time was of 92.62 8.73 minutes for group A, and of 78.63 7.02 minutes for group B, (p< 0.01), and the average blood loss was of 222.78 34.93 mL for group A, and of 121.61 19.85 mL for group B, (p< 0.01), which were statistically significant. The mean scores on the MEPS and DASH of both groups were found to be insignificant. Complications like infection, neurapraxia and soft tissue irritation where observed more in group A. Conclusion The triceps-reflecting approach results in a shorter operative time, a lower levels of blood loss, and a low rate of complications, and olecranon osteotomy provides better accuracy in terms of articular reduction. But there were no significant differences between the two groups regarding the functional outcome. Therefore, we have proposed a new classification that is a modification of the AO/OTA classification: type 1 includes AO grades 13A to C2 (B3 excluded); and type 2, AO 13C3. For type-1 fractures, the triceps-reflecting approach may be considered, and, for type-2 fractures, olecranon osteotomy.
Resumo Objetivo Escolher uma abordagem posterior adequada para fraturas distais do úmero em adultos. Métodos Cinquenta pacientes com fraturas distais do úmero foram analisados prospectivamente. As fraturas foram classificadas por meio da classificação Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA). Os pacientes foram divididos em grupo A e grupo B. A osteotomia olecraniana (abordagem transolecraniana) foi realizada em 30 pacientes, e a abordagem por reflexão do tríceps foi usada em 20 pacientes. Os resultados funcionais foram avaliados por meio do Mayo Elbow Performance Score (MEPS) e do questionário Disabilities of the Arm, Shoulder and Hand (DASH). Resultados O tempo médio da cirurgia foi de 92,62 8,73 minutos para o grupo A, e de 78,63 7,02 minutos para o grupo B (p< 0,01) e a média da perda sanguínea foi de 222,78 34,93 mL no grupo A, e de 121,61 19,85 mL no grupo B (p< 0,01), os quais foram estatisticamente significativos. As pontuações médias no MEPS e no DASH de ambos os grupos foram consideradas insignificantes. Complicações como infecção, neurapraxia e irritação de tecidos moles foram mais observadas no grupo A. Conclusão A abordagem por reflexão do tríceps resulta em menor tempo de operação, menor perda de sangue, e baixas taxas de complicações, e a osteotomia olecraniana proporciona uma melhor precisão da redução articular. Mas não houve diferença significativa entre os dois grupos em termos do resultado funcional. Por isso, propusemos uma nova classificação, que é uma modificação da classificação AO/OTA: o tipo 1 inclui os graus AO 13A a C2 (excluído o B3); e o tipo 2, AO 13C3. Para fraturas do tipo 1, a abordagem por reflexão do tríceps pode ser considerada, e, para as fraturas do tipo 2, a osteotomia olecraniana.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Osteotomy , Olecranon Process , Humeral Fractures/surgery , Prospective Studies , Surveys and QuestionnairesABSTRACT
ABSTRACT Objective evaluate the functional treatment outcome of deviated transverse olecranon fractures (Mayo 2A) after treatment with tension-banded intramedullary screw (PIBT) compared to classical tension band (BTC). Methods Prospectively collect all deviated transverse olecranon fractures from 2012 to 2016 and randomize them into PIBT and BTC groups. Range of motion (ROM) was measured after 2 and 5 weeks, 3 and 6 months, and 1 and 2 years. Functional assessments (DASH, Oxford Elbow Score, and Mayo Elbow Performance Index) were performed after 3 and 6 months and 1 and 2 years. Complications were collected up to 2 years of follow-up. Results 22 patients were included, 11 in each group. The mean age was 47.9 years, and the left side was injured in 13 (59.0%) patients. All patients completed the 2-year follow-up. There was no ROM difference at any time between the two groups (p> 0.005). Flexion and extension gain was maximum at three months and remained unchanged until two years. Neither flexion nor extension returned to normal, missing around 10°. Pronation and supination returned to normal. All three functional scores showed almost complete recovery of elbow function after three months postoperatively, with no difference between the groups. No group had complications, no reoperation, and no implant removal. Conclusion PIBT had similar results in ROM and functional score compared to BTC. Both had low complication rates and no need for implant removal. Level of evidence I; Randomized Trial.
RESUMO Objetivo Avaliar o resultado funcional do tratamento das fraturas transversas desviadas do olécrano (Mayo 2A) após o tratamento com parafuso intramedular com banda de tensão (PIBT) em comparação com a banda de tensão clássica (BTC). Métodos Foram coletados prospectivamente todas as fraturas transversas do olécrano desviadas de 2012 a 2016 e randomizá-las em dois grupos: PIBT e BTC. A amplitude de movimento (ADM) foi medida após 2 e 5 semanas, 3 e 6 meses e 1 e 2 anos. As avaliações funcionais (DASH, Oxford Elbow Score e Mayo Elbow Performance Index) foram realizadas após 3 e 6 meses e 1 e 2 anos. As complicações foram coletadas até 2 anos de acompanhamento. Resultados Foram incluídos 22 pacientes, 11 em cada grupo. A idade média foi de 47,9 anos, e o lado esquerdo foi lesado em 13 (59,0%) pacientes. Todos os pacientes completaram o acompanhamento de 2 anos. Não houve diferença na ADM em nenhum momento entre os dois grupos (p> 0,005). O ganho de flexão e extensão foi máximo aos 3 meses e permaneceu inalterado até 2 anos. Nem a flexão nem a extensão voltaram ao normal, faltando em torno de 10º. A pronação e a supinação voltaram ao normal. Todos os três escores funcionais mostraram uma recuperação quase completa da função do cotovelo após 3 meses de pós-operatório, sem diferença entre os grupos. Nenhum grupo apresentou complicações, nem reoperação ou retirada do implante. Conclusão O PIBT teve resultados semelhantes na ADM e pontuação funcional em comparação com o BTC. Ambos tiveram baixas taxas de complicações e não há necessidade de remover implantes. Nível de evidência I; Estudo clínico randomizado.
ABSTRACT
OBJECTIVE@#To investigate the clinical effect of double mini-locking plates in the treatment of ulna olecranon fractures.@*METHODS@#From March 2017 to May 2020, 19 patients with olecranon fractures were treated with double mini locking plates, including 12 males and 7 females, aged from 20 to 75 years old with an average of (40.50±7.62) years old;10 patients had the injuries on the left side and 9 patients on the right side. All the 19 patients were fresh closed fractures without ulnar coronoid process fracture, elbow dislocation and other injuries. The fracture healing time and complications were recorded, and the clinical efficacy was evaluated by Mayo elbow performance score (MEPS) before operation and 12 months after operation.@*RESULTS@#All the 19 patientswas followed up, and the duration ranged from 12 to 17 months with an average of (13.51±3.17) months. Postoperative follow-up showed all fractures healed. Fracture healing time ranged from 2 to 6 months, with an average of(3.77±1.24) months. There was no internal fixation fracture, screw loosening, infection, internal fixation irritation, heterotopic ossification, elbow stiffness and other complications occurred. The MEPS score of affected elbow at 12 months after operation was 91.26±3.87, which was significantly different from that before operation 56.18±9.56 (@*CONCLUSION@#It is a reliable fixation method to treat olecranon fracture with double mini locking plate. The incision lengh is small and the fracture fixation is reliable. Elbow joint function exercise can be performed early after operation. Postoperative internal fixation has less skin irritation and satisfactory elbow joint function recovery.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bone Plates , Elbow Joint , Fracture Fixation, Internal , Olecranon Process , Treatment Outcome , Ulna FracturesABSTRACT
OBJECTIVE@#To explore clinical effect of olecranon sled in treating olecranal fracture.@*METHODS@#Four patients with olecranal fracture treated by olecranon sled in March 2017, including 2 males and 2 females, age of 40, 46, 47, 72 years old, 3 patients on the left side and 1 patient on the right side. All patients were caused by falling down. Fracture were transverse, oblique and slightly compressive articular surface fracture. The time from injury to operation ranged from 1 to 3 days. Operative time, blood loss, complications and flexion and extension of elbow joint, and function of forearm were observed, VAS score was used to evaluate relieve degree of pain, and Mayo score was applied to assess recovery of elbow function.@*RESULTS@#Four patients were followed up until September 2018. Operative time ranged from 40 to 60 min, blood loss was for 20 to 40 ml, and no complications occurred. All fracture were healed at 4 months after operation. Elbow flexion was for 140° to 150°, extension of elbow was from 0° and extend to 10°, activity of flexion and extension ranged from 140 ° to 160°, MEPS score was 100. No pain occurred during doing activity, and VAS score was 0.@*CONCLUSIONS@#Low-profile design and integrated design of olecranon sled could avoid irritation of tension band and plate, and it is a simple and ideal internal fixation method for simple and mildly comminuted olecranon fracture, which is not suitable for severely comminuted olecranon fracture.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bone Plates , Elbow Joint , Fracture Fixation, Internal , Fractures, Comminuted , Olecranon Process , Range of Motion, Articular , Treatment Outcome , Ulna FracturesABSTRACT
ABSTRACT Objective The current study aims at a functional analysis of trans-olecranon lateral pinning for displaced supracondylar fracture of the humerus (SCFH) in children. Methods A prospective study of 48 children (30 males, 18 females; mean age: 7.4 years) with displaced SCFH was treated at this institution with modified technique from March 2011 to September 2014. Cases were selected on the basis of inclusion criteria. The functional outcome was assessed clinically by modified Flynn's criteria along with achievement of full range of motion. Results All 48 children with a mean follow up of 20 months (range: 6-26 months) were assessed. All fractures united well. With modified Flynn's criteria, results were excellent in 40 children (83.3%), good in six children (12.5%), and fair in two children (4.2%). There were no poor results. Preoperative nerve palsies seen in four children recovered at ten weeks. Full range of motion was achieved on an average of 20 days after K-wire removal and no new post-operative nerve palsies were noted. Conclusion The modified trans-olecranon fossa four-cortex purchase (TOF-FCP) technique was promising in all cases of unstable SCFH without the complications of loss of reduction or iatrogenic ulnar nerve injury. This technique is simple, safe, and reproducible, with good clinical results in this type of fracture.
RESUMO Objetivo Analisar funcionalmente a fixação lateral através da fossa olecraniana em fraturas supracondilianas deslocadas do úmero (FSDU) em crianças. Métodos Estudo prospectivo de 48 crianças (30 do sexo masculino, 18 do feminino, idade média: 7,4 anos) com FSDU, tratados nesta instituição entre março de 2011 e setembro de 2014 com uma técnica modificada. Os casos foram selecionados com base em critérios de inclusão. O resultado funcional foi avaliado clinicamente pelos critérios de Flynn modificados, juntamente com a feitura da amplitude de movimento completa. Resultados Todas as 48 crianças foram avaliadas, com seguimento médio de 20 meses (intervalo: seis a 26). Todas as fraturas apresentaram boa união. De acordo com os critérios de Flynn modificados, os resultados foram excelentes em 40 crianças (83,3%), bons em seis (12,5%) e razoáveis em duas (4,2%). Não foram observados resultados ruins. As paralisias nervosas pré-operatórias observadas em quatro crianças se resolveram após dez semanas. Os pacientes alcançaram amplitude completa de movimento em uma média de 20 dias após a remoção dos fios de Kirschner e não foram observadas novas paralisias nervosas pós-operatórias. Conclusão A técnica modificada de fixação em quatro corticais através da fossa transoleocraniana (FQC-FTO) foi promissora em todos os casos de FSDU instável, não apresentou complicações de perda de redução ou lesão do nervo ulnar iatrogênico. A técnica é simples, segura e reprodutível, com bons resultados clínicos nesse tipo de fratura.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Olecranon Process/injuries , Fracture Fixation, Internal , Humeral FracturesABSTRACT
<p><b>OBJECTIVE</b>To compare the efficacy of Kirschner wire tension band with hole and common Kirschner wire tension band in the treatment of olecranon fractures in adults, so as to guide the selection of clinical surgical procedures.</p><p><b>METHODS</b>From July 2011 to October 2015, a total of 49 patients with olecranon fractures underwent open reduction and fixation with Kirschner wire tension band, which were retrospectively analyzed. Of the 49 patients, 21 patients(group A) were treated with Kirschner wire tension band with hole, including 12 males and 9 females, with an average age of(37.6 ±8.2) years old;28 patients(group B) were treated with common Kirschner wire, including 18 males and 10 females, with an average age of(38.9±7.3) years old. There were no statistically significant differences between the two groups in general data. The differences of operative duration, frequency of radiation, fracture healing time, complications and postoperative elbow function scores between the two groups were observed and analyzed by parallel statistical analysis.</p><p><b>RESULTS</b>In group A, the operative duration was(60.4±10.7) min, the average number of radiation times was (12.5±2.9); in group B, the operative duration was (62.3±11.8) min, and the average radiation times was(13.7±3.8); there was no significant difference in operative time and radiation times between the two groups (P >0.05). In group A, the fracture healing time was (13.2±2.6) weeks without K-wire migration, skin irritation and other complications; and fracture healing time in group B was(14.6±1.8) weeks with complications(K-wire migration in 6 cases, skin irritation in 7 cases, internal fixation failure in 2 cases);the fracture healing time of group A was shorter than that in group B. Evaluation of elbow joint function in two groups of patients after operation showed that in group A, pain score was 41.0±3.5, movement function score was 18.0±2.1, stability score was 9.0±0.8, daily activities score was 18.0±4.3, the total average score was 87.0±7.8; and in group B, the pain score was 39.0±5.6, movement function score was 17.0±3.2, the stability score was 8.0±2.4, daily activities score was 16.0±5.2, the total average score was 83.0±10.7. There were no statistically significant in the scores between the two groups.</p><p><b>CONCLUSIONS</b>Compared with ordinary Kirschner wire, the treatment of olecranon fracture with Kirschner tension band with hole can shorten the time of fracture healing, significantly reduce the occurrence of complications, and do not affect the recovery of postoperative function, which is suitable for clinical use.</p>
ABSTRACT
Since the olecranon fractures are caused by relatively low-energy injuries, such as a fall from standing height, they are usually found without comminution. Less commonly they can be developed by high-energy injuries and have severe concomitant comminution or injuries to surrounding structures of the elbow. Because the fracture by nature is intra-articular with the exception of some avulsion-type fracture, a majority of olecranon fractures are usually indicated for surgical treatment. Even if there is minimal displacement, surgical treatment is recommended because there is a possibility of further displacement by the traction force of triceps tendon. The most common type of olecranon fracture is displaced, simple non-comminuted fracture (that is, Mayo type IIA fractures). Although tension band wiring was the most widespread treatment method for these fractures previously, there is some trends toward fixation using locking plates. Primary goal of the surgery is to restore a congruent joint and extensor mechanisms by accurate reduction and stable fixation so that range of motion exercises can be performed. The literature has shown that good clinical outcomes are achieved irrespective of surgical fixation technique. However, since the soft tissue envelope around the elbow is poor and the implants are located at the subcutaneous layer, implant irritation is still the most common complication associated with surgical treatment.
Subject(s)
Elbow , Exercise , Fracture Fixation , Joints , Methods , Olecranon Process , Range of Motion, Articular , Tendons , TractionABSTRACT
Since the olecranon fractures are caused by relatively low-energy injuries, such as a fall from standing height, they are usually found without comminution. Less commonly they can be developed by high-energy injuries and have severe concomitant comminution or injuries to surrounding structures of the elbow. Because the fracture by nature is intra-articular with the exception of some avulsion-type fracture, a majority of olecranon fractures are usually indicated for surgical treatment. Even if there is minimal displacement, surgical treatment is recommended because there is a possibility of further displacement by the traction force of triceps tendon. The most common type of olecranon fracture is displaced, simple non-comminuted fracture (that is, Mayo type IIA fractures). Although tension band wiring was the most widespread treatment method for these fractures previously, there is some trends toward fixation using locking plates. Primary goal of the surgery is to restore a congruent joint and extensor mechanisms by accurate reduction and stable fixation so that range of motion exercises can be performed. The literature has shown that good clinical outcomes are achieved irrespective of surgical fixation technique. However, since the soft tissue envelope around the elbow is poor and the implants are located at the subcutaneous layer, implant irritation is still the most common complication associated with surgical treatment.
Subject(s)
Elbow , Exercise , Fracture Fixation , Joints , Methods , Olecranon Process , Range of Motion, Articular , Tendons , TractionABSTRACT
We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.
Subject(s)
Bursitis , Curettage , Cytochrome P-450 CYP1A1 , Olecranon Process , OsteomyelitisABSTRACT
We reported the two cases of olecranon osteomyelitis secondary to the iatrogenic chronic relapsing septic olecranon bursitis. Infection was well eradicated by excision of the infected bursa and curettage of the eroded olecranon under the coverage of antibiotic therapy.
Subject(s)
Bursitis , Curettage , Cytochrome P-450 CYP1A1 , Olecranon Process , OsteomyelitisABSTRACT
PURPOSE: The olecranon osteotomy in intra-articular comminuted distal humerus fractures is a suggested technique for excellent exposure of articular fractures. However, complications including delayed union, nonunion of osteotomy site have been reported. Authors have applied predrilling for cannulated screw before osteotomy for achievement of rapid and accurate reposition of separation part and added wire fixation for secure stability. The purpose of this study is to evaluate the efficacy of this fixation procedure following the olecranon osteotomy during the internal fixation of intra-articular fracture of the distal humerus. MATERIALS AND METHODS: This study retrospectively analyzed 14 cases (9 women and 5 men) of intra-articular distal humerus fractures in which the olecranon osteotomy was applied. The mean age of patients was 53.4 years (range, 25 to 83 years), and the average follow-up period was 15.9 months. Eleven cases were classified as AO 13-C3, and the other 3 cases were AO 13-C2. Reduction accuracy, union period of osteotomy site on follow-up radiographs and postoperative complications related to olecranon osteotomy were evaluated. RESULTS: All osteotomized parts showed no position change and solid union with normal alignment at the last follow-up. The mean period of bony union was 3.5 months (range, 2 to 5 months). There were no complications related to olecranon osteotomy except one case of non-displaced fracture of the proximal ulnar shaft at the level of cannulated screw tip caused by forceful passive physical therapy. It was managed by conservative treatment without further problem. CONCLUSION: Predrilled cannulated screw and wire fixation following the olecranon osteotomy during internal fixation of intra-articular comminuted distal humerus fractures showed satisfactory results in the union of osteotomy site and it could be a recommendable procedure when fractures require olecranon osteotomy.
Subject(s)
Female , Humans , Elbow , Follow-Up Studies , Humerus , Intra-Articular Fractures , Olecranon Process , Osteotomy , Postoperative Complications , Retrospective StudiesABSTRACT
Objective To discuss the treatment effect of the comminuted olecranon fracture with anatomical -ly preshaped locking compression plate (LCP).Methods A retrospective analysis was done for 31 patients with com-minuted olecranon fracture who had been treated with open reduction and internal fixation with anatomically preshaped locking compression plate .According to Mayo classification ,4 patients were of type ⅠB,22 patients were of type ⅡB and 5 of type ⅢB.All the patients were followed up regularly after operation .X-rays were performed to evaluate frac-ture healing,and the function of affected elbow were evaluated according to Broberg -Morrey elbow performance score .Results With following-up time for 6 to 20 months(average 10.8 months),all patients attained fracture healing ,and the fracture healing time was 8 to 18 weeks ( average 12 weeks ) .According to Broberg-Morrey elbow performance score,23 patients were excellent ,6 cases good and 2 cases fair.The total excellent and good rate was 93.55%. Conclusion For comminuted olecroanon fractures ,using anatomically preshaped locking compression plate can attain stable fixation,perform early motion,and get satisfied results .
ABSTRACT
Objective To evaluate the treatment effects of the olecranon comminuted fracture by the angle stability prin-ciple combined with support under the articular surface. Methods From November 2008 to June 2012, 13 patients (7 male and 6 female, aged from 20 to 77 years) suffered from olecranon comminuted fracture were treated with Synthes anatomy locking com-pression plate and screws combined with Kirschner wires supporting under the articular surface through the posterior median ap-proach. Fractures occurred in the left elbow in 9 and in the right elbow in 4. According to the Mayo classification, 11 cases were classified as Mayo type IIB and 2 as IIIB. According to the Schatzker-Schmeling classification, 2 fractures were type A2, 9 type C, and 2 type D. One patient with type C fracture also had type I coronoid fracture according to Regan and Morrey classification. The Mayo elbow performance index (MEPI) and the shortened disabilities of the arm shoulder and hand (Quick-DASH) were employed to evaluate the functions. All patients took the satisfaction survey and X-ray during the follow-up. Results All patients were fol-lowed-up for 8 to 41 months. The mean ROM of the elbow joint was 112° (range, 65°-140° ), and the mean rotation angle of the forearm was 170° (range, 150°-180°). The mean score for the MEPI was 96 (range, 85-100), excellent 12, good 1. The mean score for the Quick-DASH was 6.2 (range, 0-16.7). In the satisfaction survey, 8 patients were very satisfied, 4 satisfied, 1 common level. All patients took the X-ray during the follow-up and all of them had achieved fracture union completely with the mean time period as 12.7 weeks (range, 11-24 weeks). No cubitus varus, valgus, and instability were found in all patients. No complication, such as infection, ulnar nerve injuries and etc. was found. Five patients complained about mild discomfort caused by internal fixation at 3 months after surgery. Three of them were diagnosed as joint stiffness because of ROM within 100° . One case in 3 elbow stiffness patients developed osteoarthritis after eight months, but no pain during joint activity. Internal fixation was removed in one case;an-other young patient took the operation for removal of internal fixation and release of medial ligament;the third patient refused oper-ation. Conclusion Angle stability principle (Synthes anatomy locking compression plate and screws) combined with supporting under the articular surface (Kirschner wires) can achieve stable fixation in treating olecranon comminuted fracture. It may realize the early exercise of the elbow joint with excellent clinical results. Therefore, it may be an optional choice in clinical practice.