1. M Ali, D Aspros, D Clark, A Tambe
Outcome of plate fixation of complex Olecranon fractures. A retrospective study of cases.
M Ali, D Aspros, D Clark, A Tambe
Introduction
Olecranon fracture constitutes 10% of all upper extremity fractures.
Most fractures of the olecranon are amenable to K-wire and Tension band fixation technique.
Fixation with Plate and screws is indicated in comminuted fractures, Monteggia fractures, fracture-dislocations and oblique fractures that extend distal to coronoid.
Fixation of fragmented olecranon fractures can be rendered difficult due to articular involvement, poor soft tissue cover and in open fractures.
We evaluated plate fixation of comminuted olecranon fractures with respect to bone union, complications, long term outcome and patients satisfaction.
Methods
23 consecutive patients with comminuted fractures of the olecranon presenting to our unit between 2011 to 2015 were studied. All patients had isolated olecranon fractures with no concomitant osseous injuries of the elbow.
These fractures were deemed to be unsuitable for Tension band fixation by virtue of their anatomy. Fracture fixation was undertaken using direct posterior approach with patient placed in lateral position. The fractures were fixed with pre-contoured locking plates.
Care was taken to restore articular arc and avoid shortening of the olecranon height.
The outcome was evaluated with respect to clinical (Oxford Elbow Score) and radiological findings.
Results
Thirteen females and ten males with mean age of 55 (18-97).
Fourteen were Mayo type IIB and nine were Mayo type IIIB. All had plate fixation because of the comminution.
All fixations were performed within three days from injury.
All the patients had physiotherapy post-operatively using standard physiotherapy protocol.
Eighteen patients had no complications post-operatively with good outcome with mean oxford score of 45 , full rotational ROM and mean flexion arc of 20 to 130 degrees. Two patient (out of eighteen) developed neuropraxia of the ulnar nerve which had improved over time.
Five patients had range of motion between 40 to 90 degrees with full rotational ROM.
Two patients ( out of five) required metal work removal; One developed stiffness and required and metal work removal arthrolysis and the second one developed heterotopic ossifications and needed metal work removal and long term physiotherapy with unsatisfactory outcome.
No non-unions were noted in our series.
Conclusion
Plate fixation is mandatory in fragmented, unstable olecranon fractures.
Plating is an effective and reliable method with low risk of non-union.
Pre-contoured locking plates help maintain olecranon height.
Stable fixation and restoring articular arc is important to avoid flexion/extension stiffness and commence early movements.
Low profile pre-contoured plates reduce the need for metal work removal.
Stiffness can complicate the post-operative period but the majority will respond well to physiotherapy.
References
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