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Erschienen in: MUSCULOSKELETAL SURGERY 1/2017

03.01.2017 | Review

The treatment of olecranon fractures in adults

verfasst von: A. J. Powell, O. M. Farhan-Alanie, J. K. Bryceland, T. Nunn

Erschienen in: MUSCULOSKELETAL SURGERY | Ausgabe 1/2017

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Abstract

Olecranon fractures are common. They are usually managed surgically with open reduction and either tension band wiring or plate fixation. Currently, there are few studies comparing fracture treatments. We aim to review the available literature to guide the orthopaedic surgeon on the management of these fractures. A literature review of peer-reviewed publications in international orthopaedic journals detailing olecranon fracture treatment was conducted. An additional focus was placed on the evidence base for and surgical outcomes of tension band wiring for common two-part fractures. Our novel illustrations aim to educate the reader, and our treatment algorithm provides guidance for management. 10% of all upper limb fractures involve the olecranon, and most are simple two-part injuries. These should be managed with tension band wire constructs. Non-displaced fractures can be treated conservatively. Displaced complex injuries necessitate locking plate fixation. Currently, there exits a lack of studies comparing these treatments. There may be an emerging role for intramedullary nail fixation. Non-operative management in the elderly comorbid patient remains controversial. Prospective, randomised controlled trials of matched patients and fracture patterns comparing operative techniques are needed as there is a lack of level I/II evidence to support the use of one implant over another.
Literatur
2.
Zurück zum Zitat Edwards SG, Cohen MS, Lattanza LL, Iorio ML, Daniels C, Lodha S, Smucny M (2012) Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience. J Shoulder Elbow Surg 21(12):1637–1643CrossRefPubMed Edwards SG, Cohen MS, Lattanza LL, Iorio ML, Daniels C, Lodha S, Smucny M (2012) Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience. J Shoulder Elbow Surg 21(12):1637–1643CrossRefPubMed
3.
Zurück zum Zitat Duckworth AD, McQueen MM (2013) Letter regarding “olecranon fractures”. J Hand Surg Am 38(6):1263CrossRefPubMed Duckworth AD, McQueen MM (2013) Letter regarding “olecranon fractures”. J Hand Surg Am 38(6):1263CrossRefPubMed
4.
Zurück zum Zitat Ring D (2011) Open reduction and internal fixation of olecranon fractures, chap 30. In: Tornetta III et al Operative techniques in orthopaedic trauma surgery. Lippincott Williams & Wilkins, Philadelphia, pp 252–258 Ring D (2011) Open reduction and internal fixation of olecranon fractures, chap 30. In: Tornetta III et al Operative techniques in orthopaedic trauma surgery. Lippincott Williams & Wilkins, Philadelphia, pp 252–258
5.
Zurück zum Zitat Ring D, Jupiter JB, Simpson NS (1998) Monteggia fractures in adults. J Bone Joint Surg Am 80A:1733–1744CrossRef Ring D, Jupiter JB, Simpson NS (1998) Monteggia fractures in adults. J Bone Joint Surg Am 80A:1733–1744CrossRef
6.
Zurück zum Zitat Morrey BF (1995) Current concepts in the treatment of fractures of the radial head, the olecranon, and the coranoid. J Bone Joint Surg Am 77(2):316–327CrossRef Morrey BF (1995) Current concepts in the treatment of fractures of the radial head, the olecranon, and the coranoid. J Bone Joint Surg Am 77(2):316–327CrossRef
7.
Zurück zum Zitat Schatzker J (1987) Fractures of the olecranon. In: Schatzker J, Tile M (eds) The rationale of operative fracture care. Springer, Berlin, pp 89–95CrossRef Schatzker J (1987) Fractures of the olecranon. In: Schatzker J, Tile M (eds) The rationale of operative fracture care. Springer, Berlin, pp 89–95CrossRef
8.
Zurück zum Zitat Muller ME, Allgöwer M, Schneider R (1991) manual of internal fixation: techniques recommended by the AO-ASIF Group. Springer, BerlinCrossRef Muller ME, Allgöwer M, Schneider R (1991) manual of internal fixation: techniques recommended by the AO-ASIF Group. Springer, BerlinCrossRef
9.
Zurück zum Zitat Rommens PM, Küchle R, Schneider RU et al (2004) Olecranon fractures in adults: factors influencing outcome. Injury 35:1149–1157CrossRefPubMed Rommens PM, Küchle R, Schneider RU et al (2004) Olecranon fractures in adults: factors influencing outcome. Injury 35:1149–1157CrossRefPubMed
10.
11.
Zurück zum Zitat Morrey BF (ed) (2000) The elbow and its disorders, 3rd edn. WB Saunders, Philadelphia Morrey BF (ed) (2000) The elbow and its disorders, 3rd edn. WB Saunders, Philadelphia
12.
Zurück zum Zitat Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of fractures of the proximal ulna. Injury 43(3):343–346CrossRefPubMed Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of fractures of the proximal ulna. Injury 43(3):343–346CrossRefPubMed
13.
Zurück zum Zitat Quintero J, Varecka T (2013) Olecranon, radial head and complex elbow injuries, Chap 6.3.1. In: Ruedi TP, Buckley RE, Moran CG (eds) AO principles of fracture management. Specific fractures, vol 2, pp 628–633 Quintero J, Varecka T (2013) Olecranon, radial head and complex elbow injuries, Chap 6.3.1. In: Ruedi TP, Buckley RE, Moran CG (eds) AO principles of fracture management. Specific fractures, vol 2, pp 628–633
14.
Zurück zum Zitat Hoppenfeld S, deBoer P, Buckley R (eds) (2009) The elbow, chap 3. Surgical exposures in orthopaedics, the anatomic approach. Lippincott Williams & Wilkins, Philadelphia Hoppenfeld S, deBoer P, Buckley R (eds) (2009) The elbow, chap 3. Surgical exposures in orthopaedics, the anatomic approach. Lippincott Williams & Wilkins, Philadelphia
15.
Zurück zum Zitat Hutchinson DT, Horwitz DS, Ha G, Thomas CW, Bachus KN (2003) Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am 85-A(5):831–837CrossRefPubMed Hutchinson DT, Horwitz DS, Ha G, Thomas CW, Bachus KN (2003) Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am 85-A(5):831–837CrossRefPubMed
16.
Zurück zum Zitat Wilson J, Bajwa A, Kamath V et al (2011) Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br 93(2):245–250CrossRefPubMed Wilson J, Bajwa A, Kamath V et al (2011) Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br 93(2):245–250CrossRefPubMed
17.
Zurück zum Zitat Prayson MJ, Iossi MF, Buchalter D, Vogt M, Towers J (2008) Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: a magnetic resonance imaging analysis. J Shoulder Elbow Surg 17(1):121–125CrossRefPubMed Prayson MJ, Iossi MF, Buchalter D, Vogt M, Towers J (2008) Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: a magnetic resonance imaging analysis. J Shoulder Elbow Surg 17(1):121–125CrossRefPubMed
18.
Zurück zum Zitat Van der Linden SC, Van Kampen A, Jaarsma RL (2012) K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 21(3):405–411CrossRefPubMed Van der Linden SC, Van Kampen A, Jaarsma RL (2012) K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 21(3):405–411CrossRefPubMed
19.
Zurück zum Zitat Lalliss SJ, Branstetter JG (2010) The use of three types of suture and stainless steel wire tension banding for the fixation of simulated olecranon fractures: a comparison study in cadaver elbows. J Bone Joint Surg Br 92(2):315–319CrossRefPubMed Lalliss SJ, Branstetter JG (2010) The use of three types of suture and stainless steel wire tension banding for the fixation of simulated olecranon fractures: a comparison study in cadaver elbows. J Bone Joint Surg Br 92(2):315–319CrossRefPubMed
20.
Zurück zum Zitat Hume MC, Wiss DA (1992) Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 285:229–235 Hume MC, Wiss DA (1992) Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 285:229–235
21.
Zurück zum Zitat Nowak TE, Burkhart KJ, Mueller LP, Mattyasovszky SG, Andres T, Sternstein W, Rommens PM (2010) New intramedullary locking nail for olecranon fracture fixation–an in vitro biomechanical comparison with tension band wiring. J Trauma 69(5):E56–E61CrossRefPubMed Nowak TE, Burkhart KJ, Mueller LP, Mattyasovszky SG, Andres T, Sternstein W, Rommens PM (2010) New intramedullary locking nail for olecranon fracture fixation–an in vitro biomechanical comparison with tension band wiring. J Trauma 69(5):E56–E61CrossRefPubMed
22.
Zurück zum Zitat Huang T-W, Wu C-C, Fan K-F et al (2010) Tension band wiring for olecranon fractures: relative stability of Kirschner wires in various configurations. J Trauma 68(1):173–176CrossRefPubMed Huang T-W, Wu C-C, Fan K-F et al (2010) Tension band wiring for olecranon fractures: relative stability of Kirschner wires in various configurations. J Trauma 68(1):173–176CrossRefPubMed
23.
24.
Zurück zum Zitat Quintero J (2000) In: Ruedi TP, Murphy WM (eds) AO principles of fracture management. Thieme, Stuttgart, pp 323–339 Quintero J (2000) In: Ruedi TP, Murphy WM (eds) AO principles of fracture management. Thieme, Stuttgart, pp 323–339
25.
Zurück zum Zitat Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P (2010) Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 130(4):459–464CrossRefPubMed Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P (2010) Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg 130(4):459–464CrossRefPubMed
26.
Zurück zum Zitat Wild JR, Askam BM, Margolis DS, Geffre CP, Krupinski EA, Truchan LM (2012) Biomechanical evaluation of suture augmented locking plate fixation for proximal third fractures of the olecranon. J Orthop Trauma 26(9):533–538CrossRefPubMed Wild JR, Askam BM, Margolis DS, Geffre CP, Krupinski EA, Truchan LM (2012) Biomechanical evaluation of suture augmented locking plate fixation for proximal third fractures of the olecranon. J Orthop Trauma 26(9):533–538CrossRefPubMed
27.
Zurück zum Zitat Argintar E, Cohen M, Eglseder A, Edwards S (2013) Clinical results of olecranon fractures treated with multiplanar locked intramedullary nailing. J Orthop Trauma 27(3):140–144CrossRefPubMed Argintar E, Cohen M, Eglseder A, Edwards S (2013) Clinical results of olecranon fractures treated with multiplanar locked intramedullary nailing. J Orthop Trauma 27(3):140–144CrossRefPubMed
28.
Zurück zum Zitat An KN, Morrey BF, Chao EY (1986) The effect of partial removal of proximal ulna on elbow constraint. Clin Orthop Relat Res 209:270–279 An KN, Morrey BF, Chao EY (1986) The effect of partial removal of proximal ulna on elbow constraint. Clin Orthop Relat Res 209:270–279
30.
Zurück zum Zitat Parker MJ, Richmond PW, Andrew TA, Bewes PC (1990) A review of displaced olecranon fractures treated conservatively. J R Coll Surg Edinb 35(6):392–394PubMed Parker MJ, Richmond PW, Andrew TA, Bewes PC (1990) A review of displaced olecranon fractures treated conservatively. J R Coll Surg Edinb 35(6):392–394PubMed
31.
Zurück zum Zitat Veras Del Monte L, SireraVercher M, Busquets Net R, Castellanos Robles J, Carrera Calderer L, Mir Bullo X (1999) Conservative treatment of displaced fractures of the olecranon in the elderly. Injury 30:105–110CrossRefPubMed Veras Del Monte L, SireraVercher M, Busquets Net R, Castellanos Robles J, Carrera Calderer L, Mir Bullo X (1999) Conservative treatment of displaced fractures of the olecranon in the elderly. Injury 30:105–110CrossRefPubMed
32.
Zurück zum Zitat Bailey CS, MacDermid J, Patterson SD et al (2001) Outcome of plate fixation of olecranon fractures. J Orthop Trauma 15(8):542–548CrossRefPubMed Bailey CS, MacDermid J, Patterson SD et al (2001) Outcome of plate fixation of olecranon fractures. J Orthop Trauma 15(8):542–548CrossRefPubMed
33.
Zurück zum Zitat Macko D, Szabo RM (1985) Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 67(9):1396–1401CrossRefPubMed Macko D, Szabo RM (1985) Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 67(9):1396–1401CrossRefPubMed
34.
Zurück zum Zitat Papagelopoulos PJ, Morrey BF (1994) Treatment of nonunion of olecranon fractures. J Bone Joint Surg Br 76(4):627–635PubMed Papagelopoulos PJ, Morrey BF (1994) Treatment of nonunion of olecranon fractures. J Bone Joint Surg Br 76(4):627–635PubMed
35.
Zurück zum Zitat Davies M, King C, Stanley D (2005) Complications of tension band wire fixation of olecranon fractures. J Bone Joint Surg Br 87(SUPP II):160 Davies M, King C, Stanley D (2005) Complications of tension band wire fixation of olecranon fractures. J Bone Joint Surg Br 87(SUPP II):160
36.
Zurück zum Zitat Tarallo L, Mugnai R, Adani R et al (2014) Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg 134:1107–1114CrossRefPubMed Tarallo L, Mugnai R, Adani R et al (2014) Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg 134:1107–1114CrossRefPubMed
37.
Zurück zum Zitat DelSole EM, Pean CA, Tejwani NC, Egol KA (2016) Outcome after olecranon fracture repair: does construct type matter? Eur J Orthop Surg Traumatol 26(2):153–159CrossRefPubMed DelSole EM, Pean CA, Tejwani NC, Egol KA (2016) Outcome after olecranon fracture repair: does construct type matter? Eur J Orthop Surg Traumatol 26(2):153–159CrossRefPubMed
38.
Zurück zum Zitat Schliemann B, Raschke MJ, Groene P, Weimann A, Wähnert D, Lenschow S, Kösters C (2014) Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo type IIA olecranon fractures. Acta Orthop Belg 80(1):106–111PubMed Schliemann B, Raschke MJ, Groene P, Weimann A, Wähnert D, Lenschow S, Kösters C (2014) Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo type IIA olecranon fractures. Acta Orthop Belg 80(1):106–111PubMed
Metadaten
Titel
The treatment of olecranon fractures in adults
verfasst von
A. J. Powell
O. M. Farhan-Alanie
J. K. Bryceland
T. Nunn
Publikationsdatum
03.01.2017
Verlag
Springer Milan
Erschienen in
MUSCULOSKELETAL SURGERY / Ausgabe 1/2017
Print ISSN: 2035-5106
Elektronische ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-016-0449-5

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