Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus / 中国骨伤

OBJECTIVE@#To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience.@*METHODS@#From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded.@*RESULTS@#All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case.@*CONCLUSION@#Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

Olecranon sled fixation versus tension band wiring fixation in treatment of Mayo ⅡA olecranon fractures / 中华创伤骨科杂志

Objective:To compare the efficacy between olecranon sled fixation and tension band wiring fixation in the treatment of Mayo ⅡA olecranon fractures.Methods:A retrospective study was conducted to analyze the data of 54 patients with Mayo ⅡA olecranon fracture who had been admitted to Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from October 2018 to February 2021. There were 20 males and 34 females with an age of (45.5±17.7 years), and 36 left and 18 right sides. They were divided into 2 groups according to different methods of internal fixation. Group A (25 cases) was subjected to olecranon sled fixation and group B (29 cases) to tension band wiring fixation. Preoperative data, operation time, reoperations and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, the range of the elbow motion, the Mayo elbow performance score (MEPS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score were recorded to evaluate the elbow function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). There were no significant differences between the 2 groups either in follow-up time [(32.8±8.9) months for group A and (35.8±9.0) months for group B] or in operation time [60.0 (60.0, 82.5) min for group A and 60.0 (60.0, 67.5) min for group B] ( P>0.05). At the last follow-up in group A and group B, respectively, the flexion and extension of the elbow was 141.0°±8.4° and 140.0 (140.0, 150.0)°, the pronation-supination 180.0 (175.0, 180.0)° and 180.0 (175.0, 180.0)°, the MEPS score 100.0 (85.0, 100.0) and 100.0 (92.5, 100.0), and the DASH score 4.2 (1.7, 6.3) and 5.8 (1.3, 8.3), all showing no statistically significant differences between the 2 groups ( P>0.05). Olecranon skin irritation occurred in 5 patients (20.0%,5/25) in group A and in 15 patients (51.7%,15/29) in group B, and 7 patients (28.0%,7/25) in group A and 21 patients (72.4%,21/29) in group B underwent removal of internal fixation, both showing statistically significant differences between the 2 groups ( P<0.05). Conclusion:In the treatment of Mayo ⅡA olecranon fractures, compared with tension band wiring fixation, olecranon sled fixation may lead to comparable efficacy in fixation and functional recovery, but significantly reduced rates of complications and internal fixation removal.

Transolecranon fracture-dislocation: concepts and functional results of surgical treatment / Fratura luxação transolecraniana: conceitos e resultados funcionais do tratamento cirúrgico

ABSTRACT Objectives: This study aimed to evaluate the functional results of the treatment protocol for the treatment of transolecranon fracture-dislocation, by surgical reduction and osteosynthesis with plate and screws, in patients attended at a referral hospital for orthopedic trauma, with a minimum follow-up period of six months. Methods: Twenty-five individuals treated surgically from January 2014 to November 2018 were selected for a primary observational longitudinal study using questionnaires to assess upper limb and elbow function (DASH and MEPS), quality of life (SF-12), pain (visual analog scale - VAS), and radiographic evaluation in anteroposterior and lateral views of the elbow. Results: Fifteen patients were male, and the mean age was 46.8 years. All participants had their fractures consolidated, with no radiolgraphic signs of implant failure, or degenerative arthritis. Mean range of motion was reduced relative to the contralateral limb: 102.6º for flexion-extension and 132.8º for pronation-supination. The mean MEPS and DASH scores were 89.6 and 16.5 respectively. There was no residual pain in 84% of the cases according to the VAS. Conclusion: The surgical treatment proposed for transolecranon fracture-dislocations showed satisfactory results according to MEPS, DASH scores and quality of life measures. Evidence Level IV; Retrospective observational study.

RESUMO Objetivo: Avaliar os resultados funcionais do protocolo de tratamento da fratura-luxação transolecraniana, por redução cirúrgica e osteossíntese com placa e parafusos, nos pacientes atendidos em hospital de referência para trauma ortopédico, com seguimento mínimo de seis meses. Métodos: vinte e cinco indivíduos tratados cirurgicamente de janeiro de 2014 a novembro de 2018 foram selecionados para um estudo longitudinal observacional primário, utilizando questionários para avaliar a função do membro superior e cotovelo (DASH e MEPS), qualidade de vida (SF-12), dor (visual escala analógica - EVA), e avaliação radiográfica nas incidências anteroposterior e perfil do cotovelo. Resultados: Quinze pacientes eram do sexo masculino e a média de idade foi de 46,8 anos. Todos os participantes tiveram suas fraturas consolidadas, sem sinais radiográficos de falha do implante ou artrite degenerativa. A amplitude média do movimento foi reduzida em relação ao membro contralateral: 102,6º para flexo-extensão e 132,8º para pronossupinação. Os escores médios de MEPS e DASH foram 89,6 e 16,5, respectivamente. Não houve dor residual em 84% dos casos de acordo com a EAV. Conclusão: O tratamento cirúrgico proposto para a fratura-luxação transolecraniana apresentou resultados satisfatórios de acordo com MEPS, escores DASH e medidas de qualidade de vida. Nível de evidência IV; Estudo observacional retrospectivo.

How to Choose Between the Transolecranon and Triceps-Reflecting Approaches to Treat Distal Humerus Fractures in Adults: A Prospective Study / Como escolher entre as abordagens transolecraniana e por reflexão do tríceps para tratar fraturas distais do úmero em adultos: Um estudo prospectivo

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.

An Assessment of 3.5mm Reconstruction Plate Fixation in Olecranon Fractures

Background: Olecranon process is a large, curved eminence comprising of the proximal and posterior part of the ulna. It lies subcutaneously which makes it more vulnerable to injury. Due to intra-articular extension of fractures, anatomical reduction and early mobilization should be achieved in every case and usually managed surgically. Aims and Objectives: To access the results of reconstruction plate in fracture olecranon.Materials &Methods: This was a prospective study consisted of 25 cases of olecranon fractures which were managed by open reduction and internal fixation using 3.5mm reconstruction plate. Patients were followed up every month till 6 months. At each follow up visit clinical and radiological parameters were assessed: Final assessment was done at 6 months using the Mayo Elbow Performance Score.Result: According to the AO classification, Type A-1 � 7 cases, A-3 � 1case, B-1 � 13 cases, B-3 � 1 case, C-1 � 1 case, C-2 � 1 case, C-3 � 1 case. An adequate reduction was maintained in all fractured olecranon until union. Average radiological union time was 12 weeks in 72% cases, 15 weeks in 16% cases, 18 weeks in 8% cases and > 18 weeks in 4% cases. The results were graded as per the criteria laid by Rogers et al as excellent in 84% cases, good in 12% and unsatisfactory in 4% cases. 2 cases developed superficial infection and 1 deep infection and 1 delayed union.Conclusion: Open reduction and internal fixation of fracture of olecranon with 3.5mm reconstruction plate is based on sound biomechanical principle with a good functional outcome and a low incidence of complications

Mechanical Properties of Novel Interlocking Intramedullary Nail for Fixing Transverse Olecranon Fractures / 医用生物力学

Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.

Novel cross-locking intramedullary nails for olecranon: a finite element analysis and specimen experiments / 中华创伤骨科杂志

Objective:To determine the mechanical properties of our self-designed novel cross-locking intramedullary nails and the impact of number of conical locking nails on the fixation through a finite element analysis and specimen experiments.Methods:Mimics 19.0 and SolidWorks 2014 were used to create transverse fracture models of the olecranon which were subjected to fixation with respectively K-wire tension band (KTB) and our self-designed novel cross-locking intramedullary nails (NIN). The strengths of KTB and NIN fixation were analyzed by Ansys. Fifteen human ulna specimens were used to construct a transverse fracture model of the olecranon; an Instron E10000 mechanical testing machine was used to determine mechanical properties in fixation respectively with KTB, one NIN (NIN-1) and 3 NINs (NIN-3).Results:In the finite element analysis, in simulation of the forearm flexed at 45° under a 100 N load, the deformation of the fracture surface of the olecranon in fixation with KTB, NIN-1 and NIN-3 was respectively 0.131 mm, 0.123 mm and 0.121 mm. In the specimen experiments, in simulation of the forearm flexed at 45°, the maximum failure loads for fixation with KTB, NIN-1 and NIN-3 were (313.38±27.68) N, (528.56±53.58) N and (871.04±94.95) N, respectively, showing significant differences among the 3 groups ( P<0.05). The maximum failure load for NIN-3 fixation was significantly greater than that for KTB or NIN-1 fixation, and the maximum failure load for NIN-1 fixation was significantly greater than that for KTB fixation ( P<0.05). Conclusions:Compared with KTB fixation, NIN fixation is more convenient in operation and has better mechanical properties. NIN-3 fixation has the best mechanical properties.

Sled board internal fixation for olecranon fractures / 中华创伤骨科杂志

Objective:To investigate the therapeutic effects of sled board internal fixation on the treatment of olecranon fractures.Methods:The clinical data were retrospectively analyzed of the 21 patients with olecranon fracture who had been treated with sled board internal fixation at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital from May 2019 to January 2021. They were 11 males and 10 females with 14 left and 7 right sides affected, aged from 18 to 68 years (mean, 42.0 years). By the preoperative Mayo classification for olecranon fractures, one case was type ⅠA, 11 cases were type ⅡA and 9 cases type ⅡB; by the Schatzker classification, one case was type A, 4 cases were type B and 16 cases type C. The operation time and the complications were recorded; at the last follow-up, the range of motion of the elbow joint was recorded and the elbow function and pain were evaluated by the Mayo elbow performance score (MEPS) and visual analogue scale (VAS).Results:The 21 patients were followed up for 13 to 34 months (mean, 19.6 months) after operation. At the last follow-up, the flexion and extension of the affected elbow averaged 139.8° (from 125° to 160°), and the pronation-supination 177.9° (from 160° to 180°). The operation time averaged 77.8 min (from 40 to 135 min). Postoperative olecranon skin discomfort developed in 4 patients, 2 of whom underwent removal of internal fixation; no such complication as internal fixation breakage, screw loosening, incision infection or elbow stiffness was observed in the other 17 cases. At the last follow-up, the MEPS scores averaged 97.9 points (from 85 to 100 points) and the VAS scores 0.2 points (from 0 to 2 points).Conclusion:The sled board internal fixation can result in good therapeutic effects on the treatment of olecranon fractures.

Wide-Awake Olecranon Tension Band Wiring with Ipsilateral Zone 6 Extensor Tendon Repair: A Case Report

@#Wide-awake local anaesthesia, no tourniquet (WALANT) continues to gain popularity and has been adapted for various fracture fixations proximal to the hand. A case of olecranon tension band wiring with concomitant extensor tendon repair is presented. The procedure was done with the patient awake in a lateral decubitus position 30min after the injection of WALANT solution at the intended surgical sites. Pain and discomfort were felt by the patient towards the end of the procedure mainly on his volar forearm where the bolster was placed. Olecranon fixation under WALANT is a viable alternative for patients who prefer to be awake or those with contraindications to general or regional anaesthesia. Alternative patient positioning may be considered, and perioperative pain control should not be overlooked.

Functional outcome of treatment of deviated olecranon fracture (mayo 2a) by an intramedullary screw with tension band compared to classic tension band - a prospective randomized study / Resultado funcional do tratamento da fratura do olécrano desviada (mayo 2a) com parafuso intramedular com banda de tensão comparado à banda de tensão clássica - estudo prospectivo randomizado

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.

Clinical observation of double mini locking plate in the treatment of olecranon fracture / 中国骨伤

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.

Related problems in anatomy mechanics, injury characteristics, fixed repair and three-dimensional technology application for olecranon fracture-dislocations / 中国组织工程研究

BACKGROUND: Olecranon fracture-dislocations are complicated fractures and dislocations of the elbow, which adds certain challenges to clinical diagnosis and treatment. Although the continuous improvement of medical standards has made some progress in the clinical diagnosis and treatment of olecranon fracture-dislocations, some controversial issues need to further discuss. OBJECTIVE: To consult and sort out the relevant literature about the clinical diagnosis and treatment of olecranon fracture-dislocations, and give a summary. METHODS: The first author searched the relevant documents collected by Web of Science, PubMed and CNKI databases from 2000 to 2020. The key words were “olecranon; elbow; fracture dislocation; 3D printing” in English and Chinese. The massive relevant literature was reviewed and collected. The literature was classified and analyzed from the aspects of anatomical mechanics, injury characteristics, diagnostic typing and surgical treatment. RESULTS AND CONCLUSION: (1) The anatomy of the olecranon, coronoid process, radial head, and the anatomical mechanical characteristics between the soft tissues affect the clinical diagnosis and treatment of olecranon fracture-dislocations. (2) Both anterior and posterior dislocations have their own injury characteristics and are easily confused with Monteggia fractures. Accurate grasp of physical examination and auxiliary imaging examination is conducive to clinical diagnosis. (3) The posterior midline approach is more commonly used, and other approaches should be combined if necessary. Proper fixation and repair of bone and soft tissue, as well as timely auxiliary external fixator, are conducive to improving the clinical efficacy of olecranon fracture-dislocations. (4) However, the damage mechanism of the rear olecranon fracture-dislocations needs to be further explored, and whether to establish independent classification of olecranon fracture-dislocations needs further discussion. The effectiveness of the indirect fixation of the coronoid process behind the olecranon still needs further research. (5) In addition, the emerging three-dimensional printing technology is of great significance for preoperative planning and simulation of bone trauma, and will be more conducive to the development of clinical diagnosis and treatment of olecranon fracture-dislocations.

Bilateral Transolecranon Fracture-Dislocation Elbow with Bilateral Coronoid and Radial Head Fractures – A Rare Complex Elbow Injury: A Case Report and Review of Literature

Bilateral olecranon fractures are a rare occurrence. Direct trauma usually results in comminuted fractures and indirect trauma in transverse fractures. We describe a case of bilateral olecranon fracture with a radial head comminuted fracture with coronoid fracture without the involvement of collaterals. Olecranon fractures are usually a result of direct trauma (fall from height/motor vehicle accidents) or indirect trauma. A 22year old male patient presented to the emergency department with complaints of pain and swelling around both elbows following a motor vehicle accident. The patient also sustained trauma to the head and had a history of transient loss of consciousness. CT brain at the time of presentation was normal and the patient was conscious. The Olecranon Fracture was fixed with a pre-contoured olecranon locking compression plate (Synthes, USA). In our case, the collaterals were intact and as the radial head was comminuted, we excised the radial head. The radial head being secondary stabilizer of the elbow in injuries to the medial collateral ligament complex. The excision of the radial head would not cause any instability. Bilateral olecranon fractures need to be fixed anatomically, the comminuted radial head was excised and the anterior capsule was repaired

Tratamiento para fractura de olécranon en pacientes mayores: Revisión sistemática / Treatment for olecranon fracture in older patients: Systematic review

Introducción El tratamiento de las fracturas de olécranon puede tener diferentes resultados, según el tipo de intervención, las características de la fractura y del paciente. Esta revisión sistemática de la literatura pretende identificar los tratamientos para el manejo de este tipo de fractura en el adulto mayor y sus resultados funcionales. Materiales y métodos Se realizó una búsqueda sistemática de la bibliografía en las bases de datos Medline, Embase y Cochrane. Se incluyeron estudios clínicos en pacientes mayores con fractura de olécranon que incluyeran resultados funcionales en sus seguimientos. Resultados De un total de 432 referencias capturadas, se incluyeron nueve estudios 6 estudios observacionales retrospectivos y 3 prospectivos. En 3 estudios se usó exclusivamente tratamiento no quirúrgico y en 4 tratamiento quirúrgico, de los cuales 2 comparan la fijación de banda de tensión con placa y 2 proponen el uso de supersuturas y suturas de anclaje. En 2 estudios comparan el tratamiento quirúrgico con el tratamiento no quirúrgico. En la evaluación de los resultados funcionales el puntaje de la Escala de Incapacidades del brazo, hombro y la mano (DASH) fue la más usada. Discusión En pacientes de edad avanzada antes de optar por fijación quirúrgica, se evalúan factores que pueden tener implicaciones en los resultados clínicos y funcionales como el número de comorbilidades y la mala calidad ósea. Este trabajo puede servir de base para la elección de tratamientos no quirúrgicos bajo condiciones requeridas, para obtener mejores resultados funcionales.

Background The treatment of olecranon fractures may lead to different outcomes, depending on the type of intervention, the characteristics of the fracture, and the patient. This systematic review of the literature aims to identify the treatments for the management of this type of fracture in the elderly and its functional results. Methods A systematic search of the bibliography was carried out in the Medline, Embase and Cochrane databases. It included clinical studies on elderly patients with olecranon fractures, as well as the functional results in their follow-up. Results Of a total of 432 references were obtained, with nine studies including 6 retrospective observational studies, and 3 prospective studies. In 3 studies, non-surgical treatment was used, and in 4 surgical treatments, 2 were comparing tension band wiring and plate fixation, and 2 proposed the use of super sutures and anchoring sutures. In 2 studies, surgical treatment was compared with non-surgical treatment. In the evaluation, the functional outcomes, the score of the Scale of disabilities of the arm, shoulder, and the hand (DASH) was the most used. Discussion In patients of advanced age, before opting for surgical fixation, factors that may have implications for clinical and functional outcomes, such as number of comorbidities and poor bone quality are evaluated. This work can serve as a basis for the choice of non-surgical treatments under the necessary conditions, and to obtain better functional results.

Fractura compleja de codo / Complex elbow fracture

Resumen: Las fracturas de codo son secundarias a traumatismos de baja y alta energía, afectan el extremo distal del húmero, olécranon, cabeza radial o una combinación de las anteriores. Las fracturas complejas de codo dificultan la reducción y su posterior fijación, lo que representa un reto para el ortopedista. Es esencial el uso de auxiliares diagnósticos como la tomografía axial computarizada para su diagnóstico y posterior tratamiento. En la actualidad, las nuevas tendencias en la fijación de las mismas y los diversos implantes con los que se cuenta pueden mejorar el pronóstico del paciente. Se presentan dos casos clínicos de fracturas complejas de codo tratadas mediante osteosíntesis.

Abstract: Elbow fractures are secondary to low or high energy trauma affecting the distal humerus, olecranon, radial head or a combination of the above. Complex fractures of the elbow complicate the reduction and its subsequent fixation representing a real challenge for the orthopedic surgeon. It is essential the use of diagnostic aids such as computerized axial tomography for diagnosis and subsequent treatment. Currently new trends in the fixation of the same and the various implants with which it is counted, can improve improve the patient's prognosis. We present two clinical cases of complex elbow fractures treated by osteosynthesis.

Clinical observation of olecranon sled for the treatment for olecranal fracture / 中国骨伤

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.

Olecranon Osteotomy Approach for Complex AO-13C Fractures of Distal Humerus: A Prospective Analysis of 24 Cases

@#Introduction: Olecranon osteotomy is well described approach for complex intra-articular distal humeral fractures. In this study, we investigated the usefulness and complications of olecranon osteotomy approach for such fractures. We hypothesise that outcome is comparable in young adults and middle age group and also functional outcome is independent of fracture subtype following surgical fixation. Materials and Methods: Between December 2012 and September 2015, twenty-four adult patients (male: 15, female: 9) having mean age of 41.4 years with closed intra-articular fracture (AO-13C) were surgically managed using olecranon osteotomy approach and were followed-up for a mean of 28.5 months (range: 22-35 months). Functional outcome was measured using Mayo Elbow Performance Score (MEPS) and complications were observed. Statistical analysis was done using Student t-test and Kruskal Wallis test. Results: All fractures united by the end of three months. Mean elbow flexion achieved was 123°, mean extension lag was 9° and mean active arc of motion was 114°. Mean MEPS was 87 (excellent: 8, good: 14, fair: 1 and poor: 1). Post-operative transient ulnar nerve palsy was noted in two cases, heterotopic ossification (HO) was in one case, infection in two cases, implant prominence in five and elbow stiffness in three cases. Motion arc was higher in young adults and MEPS was comparable in both age group. Functional outcome was also dependent on fracture subtype. Conclusion: The olecranon osteotomy approach for distal humerus fractures had good functional outcome with fewer complications. Joint congruity and fixation could easily be assessed intraoperatively.

Correlation between tibial nail length and olecrenon to 5th metacarpal head measurement: An anthropometric study / 中华创伤杂志(英文版)

Purpose:@#During fracture fixation, the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important. This study aims to find out whether "olecranon to 5th metacarpal head" (O-MH) measurement can be used to reliably predict the tibial nail length. @*Methods:@#This was a cross sectional study involving 100 volunteers. Measurements were done and recorded by two observers on two separate occasions. Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus (TT-MM). O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched. Statistical analysis was done to find out correlation between two measurements and influence of age, gender and body mass index on them. @*Results:@#Paired t-test showed no systematic error between the readings. Intraclass correlation coefficient showed strong agreement in inter and intra observer settings. Strong correlation was found between the TT-MM & O-MH measurements using Pearson's correlation coefficient test (r = 0.966). Hierarchical regression analysis showed age, gender and BMI have no statistically significant bearings on these measurements and their correlations. @*Conclusion:@#O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.

Trans-olecranon fossa four-cortex purchase lateral pinning in displaced supracondylar fracture of the humerus - a prospective analysis in 48 children / Fixação lateral em quatro corticais através da fossa olecraniana em fraturas supracondilianas deslocadas do úmero - Uma análise prospectiva em 48 crianças

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.

Neglected Anterior Dislocation of the Elbow Joint: Case Report of a Rare Injury

@#anterior dislocation of the right elbow joint in a 19-year oldman. The patient had been initially treated by a traditionalbone setter, but the elbow remained unreduced. He presentedto us with pain, deformity and limited range of motion of hisright elbow joint. Radiographs revealed an unreducedanterior dislocation of the right elbow joint. We describe theproblems encountered during open reduction andrehabilitation and result one year after the operation with thepatient having a stable elbow and a functional range ofmotion.