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Behandlung von isolierten Olekranonfrakturen

Perkutane Doppelschraubenosteosynthese vs. konventionelle Zuggurtung

Treatment of isolated fractures of the olecranon

Percutaneous double-screw fixation versus conventional tension band wiring

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Zusammenfassung

Hintergrund

Olekranonfrakturen gehören mit 7–10 % zu den mittelhäufigen Brüchen des Erwachsenen. In der Regel werden diese Frakturen operativ mittels konventioneller Zuggurtungsosteosynthese behandelt. Eine perkutane minimal-invasive Doppelschraubenosteosynthese ist eine alternative Technik bei einfacher Zwei-Fragment-Fraktur mit möglichen Vorteilen für diese selektierten Patienten.

Patienten und Methode

Es wurden 13 Patienten mit einer isolierten Olekranonfraktur vom Typ A nach Schatzker-Schmelling mittels perkutaner Doppelschraubenosteosynthese behandelt und in diese prospektive Studie eingeschlossen. Das Durchschnittsalter betrug 43,6 ± 11,0 Jahre. Die intra- und postoperativen Komplikationen wurden erfasst. Die funktionellen Ergebnisse wurden nach einer mittleren Nachuntersuchungszeit von 38,2 ± 11,5 Monaten mittels Quick-DASH („disability of shoulder, arms and hand questionnaire“) erfasst. Die Ergebnisse wurden mit einer Kontrollgruppe verglichen, bestehend aus 26 Patienten, welche beim gleichen Frakturtyp mit der konventionellen Zuggurtungsosteosynthese behandelt wurden.

Ergebnisse

In beiden Gruppen kam es zu keinen intraoperativen Komplikationen. In der Gruppe der perkutanen Doppelschraubenosteosynthese war die Narbe signifikant kürzer (2,4 ± 0,4 vs. 11,0 ± 1,8 cm; p < 0,001), das Osteosynthesematerial musste signifikant weniger häufig entfernt werden (38,5 % vs. 73,1 %). Nach einer Mindestnachbeobachtungszeit von 2 (Mittelwert 3,2) Jahren wurden in beiden Gruppen vergleichbare funktionelle Ergebnisse erzielt (Quick-DASH-Score: 2,3 vs. 0,0 Punkte; p = 0,155), wobei der Bewegungsumfang in der Gruppe der Doppelschraubenosteosynthese signifikant größer für Extension/Flexion (145 ° vs. 130 °; p < 0,001) und Pro/-Supination (165 ° vs. 155 °; p < 0,001) war als in der Gruppe der konventionellen Zuggurtung.

Schlussfolgerung

Bei Patienten mit einer einfachen Olekranonfraktur vom Typ A nach Schatzker-Schmelling liefert die perkutane Doppelschraubenosteosynthese vergleichbare Ergebnisse im DASH-Score im Vergleich zum Goldstandard, hat jedoch den Vorteil einer geringeren Revisionsrate mit besserer Beweglichkeit und Kosmetik.

Abstract

Background

Isolated fractures of the olecranon account for 7-10% of all osseous injuries in adults. These fractures are usually treated surgically by conventional tension band wiring. The percutaneous double-screw fixation is an optional treatment in patients with two fragment olecranon fractures with some postoperative advantages.

Patients and methods

A total of 13 patients with isolated fractures of the olecranon (Schatzker-Schmelling type A) treated by percutaneous double-screw fixation were included in this prospective study. The mean age of patients was 43.6 ± 11.0 years. Intraoperative and postoperative complications were recorded. Functional results were assessed after a mean follow-up of 38.2 ± 11.5 months using the Quick-DASH score. The results were compared with those obtained in the control group including 26 patients treated by conventional tension band wiring.

Results

No intraoperative complications were observed in both groups. In the group with percutaneous double-screw fixation the scar length was significantly shorter (2.4 ± 0.4 cm vs. 11.0 ± 1.8 cm, p < 0.001) and the hardware removal was substantially less frequent that in the group with conventional tension band wiring with 38.5 % and 73.1 %, respectively. At the minimum follow-up of 2 years comparable functional results were obtained in both groups (Quick-DASH score 2.3 vs. 0.0 points, respectively, p = 0.155); however, the range of elbow motionwas significantly higher in the group with percutaneous double-screw fixation (extension/flexion 145° vs. 130°, p < 0.001; pronation/supination 165° vs. 155°, p < 0.001).

Conclusions

The percutaneous double-screw fixation is a safe and viable treatment option in patients with isolated fractures of the olecranon (Schatzker-Schmelling type A). The functional results regarding DASH scores obtained using this technique were comparable with those observed in patients with conventional tension band wiring; however, range of elbow motion and cosmetic results were significantly better in the patient group with percutaneous double-screw fixation.

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  1. Klinik für Orthopädie, Universitätsklinikum Basel, Spitalstraße 21, CH-4031, Basel, Schweiz

    M. Uhlmann, A. Barg, V. Valderrabano &  G. Pagenstert

  2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland

    O. Weber & D.C. Wirtz

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  1. M. Uhlmann
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  6. G. Pagenstert
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Correspondence to G. Pagenstert.

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Uhlmann, M., Barg, A., Valderrabano, V. et al. Behandlung von isolierten Olekranonfrakturen. Unfallchirurg 117, 614–623 (2014). https://doi.org/10.1007/s00113-013-2389-y

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