Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Abstract

IntroductionOlecranon fractures are common fractures, most of them associated with damage to the soft-tissue as a result of direct trauma. Associated injuries, such as coronoid process or radial-head fractures, are present in approximately 20 % of the patients [26]. The reconstruction of the joint surfaces involves an open anatomic reduction. Subsequent treatment requires an osteosynthesis that is stable enough for early active motion [3,8,9,20]. Various forms of osteosynthesis, such as tension-band wire, intramedullary screw fixation, and plate osteosynthesis, are available for this type of reconstruction, the choice depending on the position and type of fracture. In the case of a small proximal fragment, even exstirpation of the fragment, with trans-osseous refixation of the triceps tendon, has been described [9, 10, 21]. The usual forms of osteosynthesis frequently show problems related to secure fixation. Particularly in the case of classical tensionband wiring in simple fractures, there often is proximal wire migration, resulting in pain across the tip of the olecranon and the occasional formation of fistulae, which necessitates prema- AbstractIntroduction: The open reduction and internal fixation of olecranon fractures places high demands on the fixation device regarding the osseous anchorage and soft-tissue damage. In tension-band wiring, implant loosening and failure of osteosynthesis are frequent complications following mobilization. One of the biomechanical reasons given for this is the eccentric position of the tension band. Plate osteosynthesis -reserved for the more complex types of fracture -does not always provide sufficient stability, particularly in the case of fractures associated with osteoporosis and additional medial, lateral, frontal and extremely small proximal fragments. Another problem is the subcutaneous position of the implant, which can increase soft-tissue complications. Materials and Methods: The IP-X(X)S(L) nail described here is a locking nail with the option of interfragmentary compression. It is locked by threaded K-wires and has been used for all olecranon fractures treated in our clinic since May 1999. From May 1999 until December 2002, 80 olecranon fractures were treated with the XS nail. After an average period of 15 months, 73 of these 80 (follow-up 91.3 %) patients were investigated. Included in this group were 49 (67.1 %) patients with comminuted fractures and 24 (32.9 %) patients with two-fragment fractures. Olecranon osteotomies were excluded. Results: There were six (8.2 %) cases of dislocation of the transverse locking wires, two requiring re-osteosynthesis which were without complications. Two (2.7 %) cases had to be revised because of irritation of nerve structures. No cases of acute or chronic osteitis, implant failure or non-union after primary XS-nail osteosynthesis were found. Using the Murphy score, 47 (64.4 %) excellent, 21 (28.8 %) good, 3 (4.1 %) satisfactory and 2 (2.7 %) poor re-

Intramedullärer Verriegelungs-Kompressionsnagel für die Behandlung der Olekranonfraktur

“…The change to a longer, possibly also a thinner nail has proven worthwhile in these cases as well. According to the clinical-radiologic Murphy Score [16], the results were evaluated in 47 patients (64.4%) as excellent, in 21 (28.8%) as good, in three (4.1%) as satisfactory, and in two (2.7%) as poor [9]. Only 2.6% superficial hematomas and seromas, not requiring revision, were recorded.…”

“…Nach dem klinisch-radiologischen Murphy-Score [16] wurden die Ergebnisse bei 47 Patienten (64,4%) als exzellent, bei 21 (28,8%) als gut, bei drei (4,1%) als befriedigend und bei zwei (2,7%) als schlecht bewertet [9]. Lediglich 2,6% oberflächliche und nicht revisionspflichtige Hämatome und Serome wurden verzeichnet.…”