Plate Osteosynthesis for Severe Olecranon Fractures

Abstract

Purpose. To review outcomes of 10 patients who underwent plate osteosynthesis for severe olecranon fractures. Methods. Records of 7 men and 3 women aged 33 to 73 years who underwent plate osteosynthesis for severe olecranon fractures were reviewed. All had some degree of soft-tissue injury; 6 presented with associated fractures. Seven patients were treated with a limited contact dynamic compression plate, and the remaining 3 received a locking compression plate. Patients were followed up for fracture healing, range of motion, nerve damage, heterotopic ossification, infection, hardware complaints, and the need of a secondary surgical procedure. The Mayo Elbow Performance Score (MEPS) was determined at the final follow-up. The patient-answered questionnaire (PAQ) portion of the Liverpool Elbow Score (LES) was evaluated 2 to 37 months later by telephone. 2010;18(1):80-4 2010;18(1):80-4 and severe soft-tissue swelling; all had been treated with the limited contact dynamic compression plate. Four patients underwent plate removal owing to hardware complaints. One patient underwent a secondary procedure to restore complete range of elbow motion. The mean MEPS score was 84 (range, 35-100); 5 patients attained excellent scores, one good, 2 satisfactory, and 2 unsatisfactory. The mean PAQ portion of the LES score was 31 (range, 23-36). Conclusion. Plate osteosynthesis achieves satisfactory results for severe olecranon fractures. The deep infection rate is higher in patients with severe softtissue injury. Journal of Orthopaedic Surgery

Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon

“…20 Plate choices include one-third tubular plates, 3.5-mm limited-contact dynamic compression plates or reconstruction plates, hook-like plates, and locking anatomic plates. 3,6,19,20 In a cadaveric study by Buijze and Kloen, 6 there were no differences between locking compression plates and one-third tubular plates regarding fixation rigidity and strength. Locking compression plates provide superior mechanical stability at the fracture line because they provide angular stability.…”

A survey of current practices and preferences for internal fixation of displaced olecranon fractures

“…1,3,4,15,17,19,24 However, based on our survey, 78.5% of surgeons use tension band wiring for simple displaced olecranon fractures and believe this technique is more stable (20%), produces better outcomes (35.2%) and requires less time to perform (35.2%). Thus, the beliefs and practices of the Canadian surgeons surveyed may not be completely supported by the existing evidence.…”

“…1,4 Many surgeons feel plating is a good fixation method for olecranon fractures, yielding acceptable range of motion, minimal discomfort and good results when used for simple and comminuted olecranon fractures. 1,3,17,19,24 According to our survey results, reluctance to use plating for simpler fractures was driven by cost, equivalent or better outcomes with other simpler constructs and longer duration of surgery (including more extensive dissections). In a randomized controlled trial comparing tension band wiring to plating, authors reported no difference in range of motion but significantly more hardware prominence in the tension band wiring group than the plating group (42% v. 5%).…”

“…4 Plating offers the advantage of increased stability 4,18 and may be associated with lower rates of hardware prominence. 1,4,6,17,19 However, such a construct may be considered too bulky for simpler noncomminuted fractures, be associated with longer surgery and be more costly. 15 There is controversy about which internal fixation method for displaced olecranon fractures provides optimal stability, range of motion and lack of complications (e.g., hardware prominence).…”

Validation of the Liverpool Elbow Score for evaluation of elbow stiffness

“…After being demonstrated to be a reliable, valid and responsive outcome tool, the LES began to be used to assess outcomes after total elbow replacement in the management of rheumatoid arthritis [ 7 , 8 ], posttraumatic arthritis [ 8 – 10 ], olecranon fractures [ 10 ] and distal humeral fractures [ 11 , 12 ]. However, there have been no published validation studies of LES for patients with stiff elbows undergoing arthrolysis.…”