Mitigation of Triceps Avulsion Fracture After Proximal Ulna Plate Fixation

Orbay, Jorge L.; Vernon, Lauren L.; Gibson, Keegan; Lacau, Gustavo E.; Mercer, Deana; Hoekzema, Nathan

doi:10.1097/bot.0000000000002189

Cited by 5 publications

(9 citation statements)

References 24 publications

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“…Orbay et al ( 13 ) proposed an augmented suture of the triceps tendon directly to the plate. They found that olecranon avulsion fracture became a postoperative complication after plate fixation of an olecranon fracture, which inspired their solution.…”

Section: Discussionmentioning

confidence: 99%

“…Considering these postoperative side effects and complications of TBW, plates are recommended for the fixation of olecranon avulsion fractures. However, for this fracture type, only one screw should be used to fix the small proximal fracture fragment ( 13 ). The fixation is considered to provide insufficient stability, and early postoperative functional exercise may lead to fixation failure.…”

Section: Introductionmentioning

confidence: 99%

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A novel internal fixation technique for the treatment of olecranon avulsion fracture

et al. 2023

Front. Surg.

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ObjectiveTension band wiring and proximal ulnar plate fixation are commonly used fixation methods for olecranon fractures. However, they may not be suitable for repairing proximal olecranon avulsion fractures. In this study, we present a novel fixation technique for the treatment of proximal avulsion fractures, which is a T-shaped plate combined with a wire.Materials and methodsBetween March 2016 and May 2020, surgery was performed on 16 patients with proximal olecranon avulsion fractures by using a T-shaped plate combined with a wire fixation at our hospital. The parameters followed were fracture healing time, elbow range of motion (ROM), related functional scores (the Mayo score and the DASH score), and complications related to internal fixation.ResultsThe average follow-up period was 17 (14–21) months and fractures had healed in all patients included in the study, with an average fracture union of 9.25 (8–12) weeks. No patient reported fixation failure, serious infection, or revision surgery. The average ROM of the elbow joint was 123° (120–135°). The Mayo score was excellent in 11 patients and good in 5. The average DASH score was 17.75 (12–24).ConclusionOlecranon avulsion fractures were fixed with a T-shaped steel plate combined with a steel wire, which can be used for early functional exercise and for achieving good final functional results. This method can provide stable fixation, especially in elderly patients with osteoporosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A novel internal fixation technique for the treatment of olecranon avulsion fracture

et al. 2023

Front. Surg.

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“…The authors found that the most common mode of failure was the loss of fixation of the proximal olecranon fragment. Orbay et al conducted a similar biomechanical study of 10 paired cadaveric specimens, in which 1 arm from each pair underwent an additional augmented suture repair after plate fixation of a transverse olecranon osteotomy where the triceps tendon was sutured directly to the plate 5 . With suture augmentation, 4 elbows failed through triceps rupture.…”

Section: Discussionmentioning

confidence: 99%

“…Risk of failure may have been increased by iatrogenic damage to the tendon when split for plate placement or through increased load placed on the tendon with suture augmentation. Although theoretically suture augmentation should be protective of the triceps insertion, the data from Orbay et al suggest that suturing the triceps to the plate, while protective of the fracture, may actually increase the risk of tendon rupture 5 . A limitation of our case report is the possibility that the triceps ruptured independently because of the mechanism of the injury, and therefore, the longitudinal split and suture augmentation may not have contributed.…”

Section: Discussionmentioning

confidence: 99%

“…This mechanism is often termed “olecranon escape” 4 . To mitigate this risk, off-loading triceps suture techniques have been described as a load-sharing mechanism to decrease distraction forces imposed by the extensor mechanism 4,5 . Distal triceps rupture after olecranon fixation, on the other hand, is not described readily in olecranon fixation literature 6,7 .…”

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confidence: 99%

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Triceps Rupture After Olecranon Fixation with Proximal Ulna Plate and Suture Augmentation

Flores,

Sheridan,

Larson

et al. 2023

JBJS Case Connector

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Case: Olecranon fractures treated with proximal ulna plate fixation and repairing the triceps with suture augmentation to the plate decrease the risk of “olecranon escape,” but may lead to failure through triceps rupture. In this case report, a rare complication of triceps rupture occurred, and the patient underwent triceps repair. Conclusion: When fixing olecranon fractures, surgeons should minimize triceps dissection for hardware placement. If subjected to significant force, a surgical insult to the tendon footprint for a better plate contact on the bone and the presence of suture augmentation may change the construct failure mechanism and result in triceps rupture as opposed to fracture redisplacement.

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Efficacy comparison of Kirschner-wire tension band and anchor loop plate in treatment of olecranon fracture

Du,

Su,

et al. 2023

Front. Bioeng. Biotechnol.

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Objective: This study aimed to introduce a new surgical method for the fixation of olecranon fractures, and to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band and anchor loop plate (ALP) in the treatment of olecranon fractures.Methods: A finite element model was established to analyze the mechanical properties of Kirschner wire tension and anchor loop plate fixation for olecranon fracture. The clinical data of 53 patients with olecranon fractures admitted to our hospital from March 2016 to October 2021 were retrospectively analyzed. Among them, 22 cases were fixed with an anchor loop plate (ALP group), and 31 patients were fixed with the Kirschner wire tension band technique. By reviewing the medical records and follow-up results, the final elbow mobility, secondary surgery, postoperative complications and elbow function recovery Mayo score and DASH score were compared between the two groups.Results: The biomechanical analysis of the finite element model showed that under the load of 120 N, the maximum displacement of the Kirschner wire group was 1.09 times that of the ALP group, the maximum stress of the Kirschner wire group was 1.33 times that of the ALP group, and the maximum stress of the olecranon proximal bone of the Kirschner wire group was 2.17 times that of the ALP group. Under the load of 200 N, the maximum displacement of the Kirschner wire group was 1.19 times that of the ALP group. The overall maximum stress of the Kirschner wire group was 1.59 times that of the ALP group, and the maximum stress of the proximal olecranon bone of the Kirschner wire group was 1.99 times that of the ALP group. The average follow-up time of the Kirschner wire and anchor loop plate groups was similar (p > 0.05). The average age of the two groups was identical (p > 0.05). The final elbow mobility in the anchor loop plate group was significantly greater than in the Kirschner wire group (p < 0.05). The Mayo score of the anchor loop plate group was substantially higher than that of the Kirschner wire group at 3 and 12 months after operation (p < 0.05), and the DASH score was significantly lower than that of the Kirschner wire group (p < 0.05). Postoperative complications in the two groups: 1 case (4.5%) in the anchor loop plate group had difficulties with internal fixation stimulation, and no infection occurred; in the Kirschner wire group, 5 cases (16.1%) had complications of internal fixation stimulation, and 1 patient (3.2%) had an infection.Conclusion: The model of olecranon fracture fixed by anchor loop plate and Kirschner wire tension technique was tested under 120 and 200 N tension, and no damage was found, indicating that the newly designed anchor loop plate was safe in mechanical structure. The biomechanical stability of the anchor plate technique is more stable, so it is not easy to have postoperative complications such as fracture block cutting and internal fixation failure. And the secondary operation rate and elbow function have better results. This technique is an effective method for the treatment of olecranon fractures.

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Mitigation of Triceps Avulsion Fracture After Proximal Ulna Plate Fixation

Cited by 5 publications

References 24 publications

A novel internal fixation technique for the treatment of olecranon avulsion fracture

A novel internal fixation technique for the treatment of olecranon avulsion fracture

Triceps Rupture After Olecranon Fixation with Proximal Ulna Plate and Suture Augmentation

Efficacy comparison of Kirschner-wire tension band and anchor loop plate in treatment of olecranon fracture

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