Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna

Seong-Eun Byun; Ho-Jae Lee; Junhyun Kim; Sang-June Lee; Uk Kim; Soo-Hong Han

doi:10.4055/jkoa.2016.51.5.403

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Byun, Lee, Kim, Lee, Kim, and Han: Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(5): 403-410.

Published online: 26 October 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.5.403

Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna

Seong-Eun Byun, M.D., Ho-Jae Lee, M.D.^*, Junhyun Kim, M.D., Sang-June Lee, M.D., Uk Kim, M.D., Soo-Hong Han, M.D., Ph.D.

Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

^*Department of Orthopedic Surgery, CHA Gumi Medical Center, CHA University, Gumi, Korea.

Correspondence to: Soo-Hong Han, M.D., Ph.D. Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. TEL: +82-31-780-5270, FAX: +82-31-780-5944, hsoohong@daum.net

Received 23 January 2016 Revised 20 February 2016 Accepted 5 May 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Bifocal fracture of the proximal ulna is a fracture of the olecranon accompanied by fracture of the coronoid process. The purpose of the current study was to analyze the clinical results of the author's technique in bifocal fracture of the proximal ulna.

Materials and Methods

Fifteen patients (10 men, 5 women) treated at CHA Bundang Medical Center from April 2006 to October 2014 were analyzed retrospectively. All patients underwent internal fixation using a locking compression plate (LCP) with retrograde screw fixation of the coronoid process through a screw hole of the plate. Mean age of the patients was 42.6 years and the mean follow-up period was 18.6 months. Comminuted coronoid fractures with hard to screw fixation, complex injuries combined with open damage, and complete ligament rupture were excluded. Fracture union and articular congruity were examined on the follow-up radiographs. Range of motion, disability of the arm, shoulder and hand (DASH) score, and Mayo elbow performance score were evaluated for functional analysis.

Results

Fracture union was achieved and articular step off was less than 2 mm in all patients on the follow-up radiographs. The mean value of modified Mayo elbow score was 92.14 (80–100) and DASH score was 7.11 at last follow-up. The mean range of motion of elbow was 128o. There was one case of small heterotopic ossification as a radiographic complication which had no functional deficit.

Conclusion

Internal fixation of bifocal multifragmentary articular fractures of the proximal ulna with anatomically contoured LCP olecranon plate and retrograde long screws could be a recommendable surgical procedure. This study showed that the precontoured plate with retrograde coronoid process screw fixation can produce good clinical and radiographic outcomes in bifocal fractures of the proximal ulna. We recommend this procedure in this type of fracture.

Keywords: proximal ulna fracture, olecranon fracture, coronoid process fracture, internal fixation

Figures and Tables

Figure 1

Intraoperative view. (A) The olecranon was initially fixed with a 3.5 mm anatomically contoured locking compression plate. (B-D) After fixation of the olecranon, the gap of the coronoid process fragment was checked with using an image intensifier. In cases of more than 2 mm of gap, the coronoid process was indirectly reduced with using a bone hook and provisional fixation with K-wire was performed done. (E) Retrograde fixation of the coronoid process was performed done using a long screw through a screw hole of the plate.

Figure 2

Pre- and postoperative imaging study. (A, B) Comminuted olecranon fracture and associated coronoid process fracture were seen observed on anteroposterior and lateral view. (C, D) The anteroposterior and lateral view at 12 months after the operation show good healing of the fracture.

Figure 3

Postoperative photographs. The photographs show a good functional result of an injured elbow with nearly normal range of motion equivalent to non-injured elbow.

Figure 4

Pre- and postoperative radiographs. (A, B) Comminuted olecranon fracture and associated coronoid process fracture were seen observed on anteroposterior and lateral view. (C, D) The anteroposterior and lateral view at 18 months after the operation show good healing of the fracture.

Figure 5

Postoperative photographs. The photographs show a good functional result of an injured elbow with nearly normal range of motion equivalent to the non-injured elbow.

Table 1

Summary of Cases

DASH, disability of the arm, shoulder and hand.

Notes

This article was announced at 2015 The Korean Fracture Society Annual Spring Conference.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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