Abstract
Background
We introduce several methods for fixation of unique Mayo type II olecranon fractures with the coronal plane fragment (CPF) including the entire coronoid process and report the radiological and clinical results through a case series.
Materials and Methods
12 patients were operated using this method with a mean age of 44 years. CPFs were fixed with concurrent fixation by a locking plate screw for the olecranon in three patients (method 1), cerclage wiring in six patients (method 2), a mini plate in two patients (method 3), and a double-locking plate (method 4) in one patient. We accessed the fragment through an additional medial coronoid approach after identifying the olecranon fragment through a dorsal approach (methods 1–3). In method 4, the CPF was fixed through a dorsal approach between the comminuted metaphyseal fragments.
Results
With the exception of one patient with delayed union, all patients had achieved union at 3-month followup. The mean flexion extension arc was 125°. The mean pronation/supination was 72.5°/71.7° (range, 60–80°/60–80°). The mean visual analog scale score for elbow pain was 0.92 (range, 0–2), and the mean Mayo Elbow Performance Score was 86.7 (range, 80–90). The mean Disabilities of the Arm, Shoulder, and Hand score was 10.2 (range, 4–14). There were no major complications.
Conclusion
A thorough preoperative understanding of the fragment patterns and preparation of tools for adequate reduction and fixation are necessary for satisfactory clinical and radiological outcomes. However, further comparative trials of conservative management versus surgery for CPF fixation, and any differences in outcomes according to the CPF fixation options, are required.
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References
Ring D. Elbow fractures and dislocations. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P, editors. Rockwood and Green’s Fractures in Adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 936–42.
Baecher N, Edwards S. Olecranon fractures. J Hand Surg Am 2013;38:593–604.
Cha SM, Shin HD, Kim KC, Noh CK. Fixation of posterior process fractures of the olecranon using a modified suture bridge technique: Report of 2 cases. J Hand Surg Am 2014;39:2434–7.
Cha SM, Shin HD, Lee JW. Application of the suture bridge method to olecranon fractures with a poor soft-tissue envelope around the elbow: Modification of the Cha-Bateman methods for elderly populations. J Shoulder Elbow Surg 2016;25:1243–50.
Fyfe IS, Mossad MM, Holdsworth BJ. Methods of fixation of olecranon fractures. An experimental mechanical study. J Bone Joint Surg Br 1985;67:367–72.
Kim W, Choi S, Yoon JO, Park HY, Kim SH, Kim JS, et al. Double tension band wiring for treatment of olecranon fractures. J Hand Surg Am 2014;39:2438–43.
Nowak TE, Burkhart KJ, Mueller LP, Mattyasovszky SG, Andres T, Sternstein W, et al. New intramedullary locking nail for olecranon fracture fixation – An in vitro biomechanical comparison with tension band wiring. J Trauma 2010;69:E56–61.
Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma 2001;15:542–8.
Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: One-third tubular versus locking compression plating. Arch Orthop Trauma Surg 2010;130:459–64.
Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 2009;91:2416–20.
Wiegand L, Bernstein J, Ahn J. Fractures in brief: Olecranon fractures. Clin Orthop Relat Res 2012;470:3637–41.
Bernstein J, Monaghan BA, Silber JS, DeLong WG. Taxonomy and treatment – A classification of fracture classifications. J Bone Joint Surg Br 1997;79:706–7.
Muller ME, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Berlin, Germany: Springer-Verlag; 1991.
Schatzker J. Fractures of the olecranon. In: Schatzker J, Tile M, editors. The Rationale of Operative Fracture Care. New York: Springer-Verlag; 1996. p. 113–9.
Giannicola G, Scacchi M, Sacchetti FM, Cinotti G. Clinical usefulness of proximal ulnar and radial fracture-dislocation comprehensive classification system (PURCCS): Prospective study of 39 cases. J Shoulder Elbow Surg 2013;22:1729–36.
Patterson SD, Bain GI, Mehta JA. Surgical approaches to the elbow. Clin Orthop Relat Res 2000;370:19–33.
Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: A comparative anatomic study. J Shoulder Elbow Surg 2001;10:380–2.
Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Terrible triad injuries of the elbow: Does the coronoid always need to be fixed? Clin Orthop Relat Res 2014;472:2084–91.
Morwood MP, Ruch DS, Leversedge FJ, Mithani SK, Kamal RN, Richard MJ, et al. Olecranon fractures with sagittal splits treated with dual fixation. J Hand Surg Am 2015;40:711–5.
Rommens PM, Küchle R, Schneider RU, Reuter M. Olecranon fractures in adults: Factors influencing outcome. Injury 2004;35:1149–57.
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Cha, S.M., Shin, H.D. Fixation of the Various Coronal Plane Fracture Fragments, Including the Entire Coronoid Process, in Patients with Mayo Type IIB Olecranon Fractures - Four Methods for Fixation. JOIO 53, 224–231 (2019). https://doi.org/10.4103/ortho.IJOrtho_42_17
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DOI: https://doi.org/10.4103/ortho.IJOrtho_42_17