Olecranon Nonunion after Operative Treatment of Fracture

Ho-Jung Kang; Ji-Sup Kim; Myung-Ho Shin; Il-Hyun Koh; Yun-Rak Choi

doi:10.12671/jkfs.2015.28.1.30

Journal List > J Korean Fract Soc > v.28(1) > 1038043

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Kang, Kim, Shin, Koh, and Choi: Olecranon Nonunion after Operative Treatment of Fracture

Original Article

Journal of the Korean Fracture Society 2015; 28(1): 30-37.

Published online: 20 January 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.1.30

Olecranon Nonunion after Operative Treatment of Fracture

Ho-Jung Kang, M.D., Ji-Sup Kim, M.D., Myung-Ho Shin, M.D., Il-Hyun Koh, M.D., Yun-Rak Choi, M.D.

Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to: Ji-Sup Kim, M.D. Department of Orthopedic Surgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3412, Fax: 82-2-573-5393, kkimjsno1@naver.com

Received 20 July 2014 Revised 27 November 2014 Accepted 3 December 2014

(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/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment.

Materials and Methods

We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion.

Results

According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases).

Conclusion

Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

Keywords: Olecranon, Nonunion

Figures and Tables

Fig. 1

Classification of olecranon nonunions.

Fig. 2

(A) Lateral radiograph of a 69-year-old man after tension band wiring. (B) At 7 months after surgery, lateral radiograph shows nonunion of olecranon and pull out of tension band wiring (white arrow). (C) At 3 months after curettage and internal fixation with a reconstruction plate, radiograph shows union.

Fig. 3

(A) Lateral radiograph of a 53-year-old man shows a comminuted olecranon fracture. (B) At 7 months after surgery, lateral radiograph shows nonunion of olecranon, inadequate reduction and malposition of the proximal screw after plate fixation. (C) Osteosynthesis with plate fixation and auto-iliac bone graft. At 9 months after surgery, the patient was pain-free, had a range of motion greater than 90°.

Fig. 4

(A) Lateral radiograph of a 30-year-old man shows inadequate mechanical stability and failure of fixation with screws. (B) Osteosynthesis with plate fixation and autoiliac bone graft. (C, D) At 14 months after surgery, radiograph shows union. (E, F) Active range of motion 14 months after surgery.

Fig. 5

(A) Initial radiograph of a 46-year-old man shows a distal humerus fracture. (B) At 9 months after open reduction and internal fixation with double plating through olecranon osteotomy, radiograph shows non-union of olecranon after tension band wiring. (C) Excision of the olecranon fragment and advancement of the triceps tendon. (D) At 5 months after second surgery, active range of motion greater than 90° and painless elbow were achieved. (E, F) Active range of motion 1 year after hardware removal.

Table 1

Classification of Olecranon Nonunions

Table 2

Preoperative/Postoperative Series

BMD: Bone mineral density, MEPS: Mayo elbow performance score, TBW: Tension band wiring, LCP: Locking compression plate, LOM: Limitation of motion, Sx: Symptom. ^*Classification of olecranon nonunions.

Notes

Financial support: None.

Conflict of interest: None.

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