Journal List > Arch Hand Microsurg > v.24(2) > 1125367

Hong, Jung, Kim, and Han: The Result of Locking Compression Plate Olecranon Plate Fixation for Unstable Comminuted Olecranon Fracture

초록

Purpose:

Olecranon fractures of Mayo type IIIb occurring in less than 15% of total olecranon fractures usually require open reduction and internal fixation with plate. Concomitant injury to the surrounding soft tissue is common and anatomi-cal reduction is relatively difficult, which may be predictive of poor prognosis compared to simple fracture. We performed open reduction and locking compression plate (LCP) olecranon plate fixation in Mayo type IIIb fractures, and analyzed the results of the treatment.

Methods:

We retrospectively analyzed 29 patients who underwent LCP plate fixation for olecranon fractures of Mayo type IIIb. Twenty four males and 5 females were included, and the average follow-up period was 17 months. Radiograph-ic analysis was performed to assess the stability of the joint, union time of the fracture, and the occurrence of traumatic arthritis at the final follow-up. We analyzed the range of motion of the elbow at the final follow-up, the Mayo elbow performance score (MEPS), the disability of the arm, shoulder and hand (DASH) score, and postoperative complications.

Results:

All cases showed bony union and stable elbow joint on simple plain radiography. On final follow-up radiogra-phy, traumatic arthritis was observed in 1 case. The mean range of motion of the elbow was 129.7°, the mean MEPS was 88.6, and DASH score was 11.04.

Conclusion:

Based on the results of this study, the satisfactory results can be obtained if appropriate open reduction and stable internal fixation using olecranon LCP plate is achieved in unstable comminuted olecranon fractures.

REFERENCES

1.Sahajpal D., Wright TW. Proximal ulna fractures. J Hand Surg Am. 2009. 34:357–62.
crossref
2.Horne JG., Tanzer TL. Olecranon fractures: a review of 100 cases. J Trauma. 1981. 21:469–72.
3.Larsen E., Lyndrup P. Netz or Kirschner pins in the treatment of olecranon fractures? J Trauma. 1987. 27:664–6.
crossref
4.Gartsman GM., Sculco TP., Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg Am. 1981. 63:718–21.
crossref
5.Hak DJ., Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000. 8:266–75.
crossref
6.Akman S., Ertürer RE., Tezer M., Tekeşin M., Kuzgun U. [Long-term results of olecranon fractures treated with tension-band wiring technique]. Acta Orthop Traumatol Turc. 2002. 36:401–7. Turkish.
7.Anderson ML., Larson AN., Merten SM., Steinmann SP. Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma. 2007. 21:386–93.
crossref
8.Bailey CS., MacDermid J., Patterson SD., King GJ. Out-come of plate fixation of olecranon fractures. J Orthop Trauma. 2001. 15:542–8.
crossref
9.Buijze G., Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am. 2009. 91:2416–20.
crossref
10.Erturer RE., Sever C., Sonmez MM., Ozcelik IB., Akman S., Ozturk I. Results of open reduction and plate osteosynthe-sis in comminuted fracture of the olecranon. J Shoulder Elbow Surg. 2011. 20:449–54.
11.Lee JM., Park JH. Fractures of the olecranon of ulna treated by plating and tension-band wiring technique. J Korean Soc Fract. 1996. 9:801–8.
crossref
12.King GJ., Lammens PN., Milne AD., Roth JH., Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. J Shoulder Elbow Surg. 1996. 5:437–41.
crossref
13.O’Driscoll SW. Technique for unstable olecranon fracture-subluxations. Oper Tech Orthop. 1994. 4:49–53.
14.Gordon MJ., Budoff JE., Yeh ML., Luo ZP., Noble PC. Comminuted olecranon fractures: a comparison of plating methods. J Shoulder Elbow Surg. 2006. 15:94–9.
crossref
15.Gardner MJ., Helfet DL., Lorich DG. Has locked plating completely replaced conventional plating? Am J Orthop (Belle Mead NJ). 2004. 33:439–46.
16.Shin HD., Yang JH., Kim PS. Internal fixation using double plates for comminuted olecranon fractures in adults. J Korean Fract Soc. 2009. 22:166–71.
crossref
17.Kim BK., Shin HD., Kim KC., Jeon YS. A retrospective comparative study of internal fixation with contoured plate using bicortical screw versus a double plate in comminuted olecranon fractures. J Korean Orthop Assoc. 2011. 46:146–51.
crossref
18.Jeong DG., Shin DJ., Byun YS., Park YB., Kim KR. The surgical outcomes of olecranon fracture dislocation of the elbow. J Korean Orthop Assoc. 2017. 52:537–42.
crossref
19.Ring D., Jupiter JB., Sanders RW., Mast J., Simpson NS. Transolecranon fracture-dislocation of the elbow. J Orthop Trauma. 1997. 11:545–50.
crossref
20.Mouhsine E., Akiki A., Castagna A, et al. Transolecranon anterior fracture dislocation. J Shoulder Elbow Surg. 2007. 16:352–7.
crossref
21.Ring D., Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am. 1998. 80:566–80.
22.Shukla DR., Pillai G., McAnany S., Hausman M., Parsons BO. Heterotopic ossification formation after fracture-dislocations of the elbow. J Shoulder Elbow Surg. 2015. 24:333–8.
crossref
23.Eriksson E., Sahlin O., Sandahl U. Late results of conserva-tive and surgical treatment of fracture of the olecranon. Acta Chir Scand. 1957. 113:153–66.
24.Rochet S., Obert L., Lepage D., Lemaire B., Leclerc G., Garbuio P. Proximal ulna comminuted fractures: fixation using a double-plating technique. Orthop Traumatol Surg Res. 2010. 96:734–40.
crossref

Fig. 1.
Preoperative plain radiographs and computed tomography scan of 65 years old male who sustained a traffic accident show Mayo type IIIb olecranon fracture.
ahm-24-133f1.tif
Fig. 2.
Follow-up radiographs taken at 6 months after surgery show bony union and stable elbow joint.
ahm-24-133f2.tif
Fig. 3.
Plate and screws were all removed at 6 months after surgery.
ahm-24-133f3.tif
Fig. 4.
Photographs of the patient taken at 1 year after surgery.
ahm-24-133f4.tif
Fig. 5.
Preoperative plain radiographs and computed tomography scan of 71 years old female who was injured by slip and fall show Mayo type IIIb olecranon fracture.
ahm-24-133f5.tif
Fig. 6.
Follow-up radiographs taken at 3 years after surgery show bony union with mild osteo-arthritic change of elbow joint.
ahm-24-133f6.tif
Fig. 7.
Photographs of the patient taken at 3 years after surgery.
ahm-24-133f7.tif
Table 1.
Patient data
Case No. Age (yr) Sex Follow-up (mo) Union (mo) ROM (o) DASH MEPS Complications Used plate
1 55 M 14 3.5 95 12.4 85 None VA-LCP+mini-plate
2 71 F 40 3 130 7.5 85 Posttraumatic OA VA-LCP
3 24 M 19 3 140 11.3 90 None VA-LCP
4 59 M 16 4 140 24.3 75 None VA-LCP
5 43 M 24 5 140 15.2 85 None VA-LCP
6 58 M 26 4 120 18.0 85 None VA-LCP
7 39 M 13 5 115 16.6 80 None VA-LCP
8 55 M 18 5 120 18.2 80 None VA-LCP
9 43 M 20 4 120 17.5 85 None VA-LCP
10 48 M 19 4 110 13.5 95 None VA-LCP+mini-plate
11 53 F 16 7 150 19.2 85 None VA-LCP
12 34 M 14 5 140 5.4 95 None VA-LCP
13 78 M 13 4 140 6.7 90 None VA-LCP
14 69 M 13 8 120 9.2 80 None VA-LCP
15 38 M 17 4 135 8.0 90 None VA-LCP
16 52 M 13 6 130 7.6 85 None VA-LCP
17 30 M 14 3 130 12.2 80 None VA-LCP
18 34 M 16 3 130 6.1 95 None VA-LCP
19 63 F 13 3 150 3.1 100 None VA-LCP
20 22 M 18 4 135 8.3 90 None VA-LCP
21 61 M 16 4 130 7.5 95 None VA-LCP
22 26 F 16 4 150 6.6 95 None VA-LCP
23 54 M 14 3 130 7.5 95 None VA-LCP
24 33 F 13 4 140 6.0 90 None VA-LCP
25 72 M 19 6.5 120 7.7 95 None VA-LCP
26 65 M 13 3 135 5.4 95 None VA-LCP
27 44 M 13 3 120 12.2 90 None VA-LCP
28 89 M 13 3.5 115 19.5 85 None VA-LCP
29 56 M 14 3 130 7.5 95 None VA-LCP
Average 50.6   16.8 4 129.7 11.04 88.6    

ROM: range of motion, DASH: disability of the arm, shoulder and hand, MEPS: Mayo elbow performance score, M: male, F: female, OA: osteoarthritis, VA-LCP: variable angle locking compression plate.

TOOLS
Similar articles