Complex Transverse Fractures of the Olecranon Treated by the Tension Band Wiring following Absorbable Pin Fixation of Articular Fragment Young Ho Lee.

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Presentation transcript:

Complex Transverse Fractures of the Olecranon Treated by the Tension Band Wiring following Absorbable Pin Fixation of Articular Fragment Young Ho Lee (1), Jung Eun Lee (2), Jihyeung Kim (1), Hyun Sik Gong (3), Goo Hyun Baek (1) Seoul National University Hospital, Seoul, South Korea; Gil Medical Center, Gachon University School of Medicine, Incheon, South Korea; Seoul National University Bundang Hospital, Gyeonggi-do, South Korea

Introduction A complex transverse olecranon fracture treated by tension bend wiring technique Unfortunately, there was no anterior bony buttress against the compression force of the articular surface of the trochlea, and the secondary reduction loss occurred.

Purpose complex transverse fracture of olecranon the Schatzker type B fracture articular impacted-depression fragment To report the clinical outcome of our method “ tension band wiring fixation after conversion to a simple transverse facture by anatomical restoration of articular fragments using absorbable pins supplemented with autologous bone graft”

Inclusion criteria: typical image pattern of the complex transverse olecranon fractures We confirmed joint-impacted fragment in coronal view in 26 patients by using preoperative simple X-ray and 3D-CT an articular impacted fragment for olecranon notch on sagittal of CT

Patients & Method from 2010 to 2016 Indication: complex transverse fracture of olecranon which had joint-impacted fragment 26 cases: Male 15, female 11 Mean age (years): 48 (range: 19 - 84) Functional outcomes: - MEPS (Mayo Elbow Performance Score) - range of the motion of the elbow joint Radiologic outcomes: simple x-ray

An articular impacted-depression fragment was observed Anatomical restoration of articular fragments using absorbable pins

supplemented with autologous bone graft → conversion to a simple transverse fracture → Tension band wiring A coronal articular joint congruency was recovered Active full range of motion of elbow joint was achieved

CASE, M/58

An articular impacted-depression fragment was observed

Anatomical restoration of articular fragments using absorbable pins

Fixation by tension band wiring using eyelet pins

Immediate postop x-ray

POD 4 year

Results All fractures were united Union period : 6 weeks (4 - 8 weeks) Joint subsidence(mm): 2 cases, but no subjective discomport (respectively, 1.2mm and 2.2 mm) Mean elbow joint flexion : 132 °(range: 110° - 145°) Mean elbow joint extension: 4 °(range: -10° - 15°) Implant problems: migration(0), breakage(0), skin perforation(0) MEPS score : 94 (range: 88-100) 26 cases (96%) achieved a good or excellent outcome

Conclusion Complex transverse fracture of olecranon which has the joint-impacted fragment anatomical restoration of articular fragments using absorbable pins supplemented with autologous bone graft → conversion to a simple transverse facture → tension band wiring → Good option!