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Objectives: This study evaluates if relative flexion or extension of the ulnohumeral joint affects the strength of repair in olecranon fractures treated with a precontoured locking plate. Methods: A cadaveric study was performed in matched pair cadaveric elbows. All soft tissue was dissected from the radius, ulna, and elbow of each specimen, leaving interosseous ligaments and joint capsules intact. Soft tissue from the humerus was dissected away, leaving only the triceps tendon and ulnar insertions intact. An oblique proximal to distal olecranon osteotomy was created in each specimen 1 cm from the tip of the olecranon. Internal fixation with standard precontoured locking plates and a Krackow augmentation suture with #2 FiberWire followed. Specimens were randomized to elbow position of 90 or 20 degrees° and loaded to failure via axial pull through the triceps. Load at failure, displacement at the time of failure, peak load, stiffness, and mechanism of failure was recorded and compared. The study was repeated a second time with the osteotomy more proximal, 0.6 cm creating a smaller fragment with less opportunities for locking screw fixation. This small fragment group was then tested as the large fragment group had. Results: There were no significant differences in load at failure, peak load, or stiffness between the elbow position in the large fragment group. Displacement at time of failure was significantly different, although not clinically relevant. Failure of fixation in this group was a mix of triceps avulsion and failure through fracture site. The smaller fragment group with less points of fixation demonstrated no statistically significant differences in any parameters. A majority of the failures were at the fracture site. Conclusions: Ulnohumeral position does not significantly affect overall construct strength even in olecranon fractures with small proximal fragments with limited points of fixation.

Proximal humerus fractures are the third most common fracture type in adults, with their incidence increasing over time. There are varied approaches to both the classification and treatment of proximal humerus fractures. Optimal treatments for this fracture type are still widely open to debate. This review summarizes the current and historical treatment modalities for proximal humerus fractures. In this paper, we provide updates on the advances and trends in the epidemiology, classification, and operative and nonoperative treatments of proximal humerus fractures.

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Background: There is considerable published research comparing single-row (SR) and double-row (DR) rotator cuff repairs. Conclusions of primary studies as well as multiple meta-analyses have differed. One underexplored factor has been the variability in techniques that are identified as “single-row” or “double-row.” Our goal was to conduct a systematic review of primary research and meta-analyses comparing SR and DR fixation techniques, with attention to the specific technique types compared. Methods: We evaluated meta-analyses and individual studies that directly compared SR and DR repairs. Primary studies from 8 high-quality meta-analyses published prior to 2014, and any Level-III or higher studies published from 2014 to 2019, were included. Specific techniques of repair were identified, and the manuscripts were classified on the basis of the specific type of simple or complex SR or DR repair that was performed. Conclusions of the studies were then assessed according to these classifications. Results: Twenty-two studies met the eligibility criteria; 9 were Level-I studies, 7 were Level-II, and 6 were Level-III. Of the 22 studies, only 3 (14%) of the studies compared a biomechanically superior complex SR technique and a DR repair. The remaining 19 (86%) of the studies utilized biomechanically inferior, simple SR techniques in their comparisons. Conclusions: While there is a large amount of published evidence comparing SR and DR rotator cuff repair techniques, there are few studies assessing how the strongest SR techniques compare with DR techniques. This identifies a deficiency in the current understanding of rotator cuff repair techniques. Future studies specifically designed with these techniques in mind will help to further the understanding of which technique is clinically and financially superior in this continuously changing medical environment. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.