Journal List > J Korean Orthop Assoc > v.52(6) > 1013563

Jeong, Shin, Byun, Park, and Kim: The Surgical Outcomes of Olecranon Fracture Dislocation of the Elbow

Abstract

Purpose

The purpose of this study is to evaluate the surgical outcomes of olecranon fracture dislocation in accordance with the direction of the dislocation.

Materials and Methods

From December 2006 to February 2016, the surgical outcome in patients who had been followed-up for a minimum of 6 months accompanied with olecranon fracture and elbow instability were reviewed retrospectively. We classified olecranon fracture as either the anterior type or the posterior type. Moreover, we evaluated the clinical results by the Mayo elbow performance scores (MEPS) and checked for any associated injury, age, injury mechanism, and complication.

Results

Fourteen patients had anterior transolecranon fracture dislocation, with an average age of 46 years. The associated lesions were radial head fractures found in 2 patients (14.3%) and coronoid process fracture found in 5 patients (35.7%). Patients with anterior transolecranon fracture showed an average MEPS of 93.2 (70–100). Eight patients with posterior olecranon fracture dislocation had an average age of 66 years (22–87 years). The associated lesions were radial head fractures in 6 patients (75.0%) and coronoid process fracture in 8 patients (100%). Patients with posterior olecranon fracture dislocation showed an average MEPS of 94.4 (80–100). In comparison with the anterior type, posterior type occurred more frequently in elders and showed a greater association with injuries, such as radial head fracture and coronoid process fracture. However, there was no significant difference between the two groups with respect to the clinical outcome.

Conclusion

There were differences in frequency of associated injuries and age in accordance with the direction of olecranon fracture dislocation. Moreover, good clinical outcomes were achieved by surgical treatment.

Figures and Tables

Figure 1

(A) Anterior olecranon fracture dislocation. (B) Posterior olecranon fracture dislocation.

jkoa-52-537-g001
Figure 2

A 58-year-old man was hit by a mass. (A) Lateral x-ray of anterior transolecranon fracture dislocation associated with distal humerus lateral condyle fracture and coronoid process fracture. (B) Open fracture of anterior transolecranon fracture dislocation. (C) Antibiotics impregnated cement implantation, which was performed on the lesion of open fracture and bone defect. (D) Removal of cement and internal fixation for the coronoid process fracture were performed on the 5th week following surgery. (E) Due to delayed infection sign of Methicillin sensitive Staphylococcus aureus, partial implant removal surgery was performed. On the final follow-up (18 months after surgery), 90° of elbow range of motion, 12°of flexion, and a Mayo elbow performance score of 70 were detected.

jkoa-52-537-g002
Figure 3

An 87-year-old woman fell on the ground and injured her left elbow. (A) Lateral x-ray of posterior olecranon fracture dislocation associated with the coronoid process fracture and radial head fracture. (B) Postoperative lateral x-ray of the patient fixed with a plate and screws. (C) After one-year, the patient had good results.

jkoa-52-537-g003
Table 1

Patient Demographics

jkoa-52-537-i001

*Secondary operation. Implant removal. RH, radial head fracture; Coronoid, coronoid process fracture; Ligament OP, ligament operation; Open, open fracture; ROM, range of motion; FC, flexion contracture; MEPS, Mayo elbow performance score; Anterior, anterior transolecranon fracture dislocation; Posterior, posterior olecranon fracture dislocation; M, male; F, female; FH, fall from a height; HM, hit by mass; TA, traffic accident; FG, fall on the ground; E, excellent; F, fair; G, good; MSSA, Methicillin sensitive Staphylococcus aureus.

Table 2

Cause of Fracture

jkoa-52-537-i002

Values are presented as number only. Anterior, anterior transolecranon fracture dislocation; Posterior, posterior olecranon fracture dislocation.

Table 3

Result of Olecranon Fracture Dislocation

jkoa-52-537-i003

Values are presented as number only, median (range), or number (%).

Anterior, anterior transolecranon fracture dislocation; Posterior, posterior olecranon fracture dislocation; ROM, range of motion; FC, flexion contracture; MEPS, Mayo elbow performance score.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Orthop Trauma. 1997; 11:545–550.
2. Wake H, Hashizume H, Nishida K, Inoue H, Nagayama N. Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force. J Orthop Sci. 2004; 9:44–50.
3. Lindenhovius AL, Brouwer KM, Doornberg JN, Ring DC, Kloen P. Long-term outcome of operatively treated fracture-dislocations of the olecranon. J Orthop Trauma. 2008; 22:325–331.
4. Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res. 2004; (429):292–300.
5. O'Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003; 52:113–134.
6. Biga N, Thomine JM. Trans-olecranal dislocations of the elbow. Rev Chir Orthop Reparatrice Appar Mot. 1974; 60:557–567.
7. Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Orthop Trauma. 1997; 11:545–550.
8. Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg. 1998; 6:215–224.
9. Bado JL. The Monteggia lesion. Clin Orthop Relat Res. 1967; 50:71–86.
10. Reckling FW. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). J Bone Joint Surg Am. 1982; 64:857–863.
11. Kamali M. Monteggia fracture. Presentation of an unusual case. J Bone Joint Surg Am. 1974; 56:841–843.
12. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. J Bone Joint Surg Am. 1974; 56:1563–1576.
13. Jupiter JB, Leibovic SJ, Ribbans W, Wilk RM. The posterior Monteggia lesion. J Orthop Trauma. 1991; 5:395–402.
14. Mouhsine E, Akiki A, Castagna A, et al. Transolecranon anterior fracture dislocation. J Shoulder Elbow Surg. 2007; 16:352–357.
15. Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am. 1998; 80:566–580.
16. Mortazavi SM, Asadollahi S, Tahririan MA. Functional outcome following treatment of transolecranon fracture-dislocation of the elbow. Injury. 2006; 37:284–288.
17. Ikeda M, Fukushima Y, Kobayashi Y, Oka Y. Comminuted fractures of the olecranon. Management by bone graft from the iliac crest and multiple tension-band wiring. J Bone Joint Surg Br. 2001; 83:805–808.
18. Ring D, Jupiter JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am. 1998; 80:1733–1744.
19. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001; 15:542–548.
20. Guerra A, Innao V. Transolecranal dislocations. Ital J Orthop Traumatol. 1982; 8:175–181.
TOOLS
Similar articles