Quantitative 3-dimensional computed tomography analysis of olecranon fractures

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Hypothesis/Background

Olecranon fractures have variable size of the proximal fragment, patterns of fragmentation, and subluxation of the ulnohumeral joint that might be better understood and categorized on the basis of quantitative 3-dimensional computed tomography analysis. Mayo type I fractures are undisplaced, Mayo type II are displaced and stable, and Mayo type III are displaced and unstable. The last is categorized into anterior and posterior dislocations. The purpose of this study was to further clarify fracture morphology between Mayo type I, II, and III fractures.

Methods

Three-dimensional models were created for a consecutive series of 78 patients with olecranon fractures that were evaluated with computed tomography. We determined the total number of fracture fragments, the volume and articular surface area of each fracture fragment, and the degree of displacement of the most proximal olecranon fracture fragment.

Results

Displaced olecranon fractures were more comminuted than nondisplaced fractures (P = .02). Displaced fractures without ulnohumeral subluxation were smallest in terms of both volume (P < .001) and articular surface involvement (P < .001) of the most proximal olecranon fracture fragment. There was no difference in average displacement of the proximal fragment between displaced fractures with and without ulnohumeral subluxation (P = .74). Anterior olecranon fracture-dislocations created more displaced (P = .04) and smaller proximal fragments than posterior fracture-dislocations (P = .005), with comparable fragmentation on average (P = .60).

Discussion/Conclusion

The ability to quantify volume, articular surface area, displacement, and fragmentation using quantitative 3-dimensional computed tomography should be considered when increased knowledge of fracture morphology and fracture patterns might be useful.

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.

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