Quantitative 3-dimensional computed tomography analysis of olecranon fractures
Section snippets
Study design, setting, and subjects
We used International Classification of Diseases, Ninth Revision (ICD-9) codes 813.01 (closed olecranon fracture) and 813.11 (open olecranon fracture) and Current Procedural Terminology code 73200 (CT upper extremity) to identify patients with an olecranon fracture who underwent CT scan of the upper extremity between January 2005 and January 2014 at 2 level I trauma centers. There were 1946 patients with ICD-9 code 813.01 and 237 with ICD-9 code 813.11. There were 297 patients younger than 18
Results
Displaced olecranon fractures (Mayo types II and III) were more comminuted (median, 4 fracture fragments; IQR, 3-6) than nondisplaced fractures (Mayo type I; median, 2.5; IQR, 2-3; P = .02). Displaced fractures without ulnohumeral subluxation (Mayo type II) were smallest in terms of both volume (median, 36; IQR, 27-44; P < .001) and articular surface (median, 34; IQR, 24-46; P < .001) involvement of the most proximal olecranon fracture fragment. There was no difference in average displacement
Discussion
Q3DCT analysis improves our understanding of fracture morphology and fracture patterns and might help improve surgical management and prognosis of olecranon fractures. The purpose of this study was to analyze differences in fracture morphology—defined as (1) overall degree of comminution, (2) volume, (3) articular surface involvement, and (4) displacement of the most proximal olecranon fracture fragment—between Mayo types I, II, and III fractures of the olecranon and anterior and posterior
Conclusion
Quantitative analysis of olecranon fractures further clarified fracture morphology of Mayo type I, II, and III fractures. Differences in average displacement and size of the proximal fragment by Mayo class may help inform management. Keeping in mind the potential spectrum bias, we found that nondisplaced or minimally displaced fractures tend to be relatively distal and that fragmented displaced fractures without ulnohumeral subluxation and anterior olecranon fracture-dislocations create smaller
Disclaimer
David C. Ring has received study-specific grants from Skeletal Dynamics and Biomet. He is a consultant for Wright Medical, Skeletal Dynamics, and Acumed. He receives honoraria from AO North America and AO International. He receives royalties from Wright Medical, Biomet, and Skeletal Dynamics. He has stock options in Illuminos. All the other authors, their immediate families, and any research foundation with which they are affiliated have not received any financial payments or other benefits
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This retrospective study was approved by our Institutional Review Board (Protocol No. 2009P001019/MGH). A waiver of informed consent was granted.