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Erschienen in:
01.09.2015 | Original Article
The role of crossing screws as a mini-invasive treatment for isolated non-comminuted olecranon fractures
Erschienen in: European Orthopaedics and Traumatology | Ausgabe 3/2015
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Background
Several options continue to evolve for treating the common olecranon fractures. The reported high percentage of skin and implant-related complications for these subcutaneous fractures raised the question about the need for a mini-invasive line of treatment that improves the results and minimizes the complications.
Methods
A prospective study of 22 patients with Mayo type IIA olecranon fractures was conducted from January 2008 to January 2012 to evaluate the use of two transcortical crossing, cannulated screws through a percutaneous or mini-open approach. Our hypothesis was that fracture compression using the transcortical partially threaded screws applied in a crossing manner will offer a stable fixation without soft tissue compromise that hastens fracture healing and carries no danger for the skin. The patients were evaluated for operation time, quality of reduction, fracture healing, implant position, elbow range of motion, stability of fixation, and presence of complications. The functional evaluation was based on the Mayo Elbow Performance Score (MEPS).
Results
All the fractures were united in accepted position without any secondary procedure to achieve union. No fixation failure or implant migration problems were encountered. The mean time for radiographic union was 9.2 (6–12) weeks. One case with type II open fracture got superficial infection. No vascular or nerve complications were found, although the anterior ulnar cortex was penetrated by one screw in two patients. At a mean follow-up of 32.6 months (range 24–48 months), the elbow range of motion (ROM) and forearm rotation were comparable to the intact side except ≤5° extension deficit in three patients, which was statistically non-significant (P = 0.0823). Using the MEPS, all the patients (100 %) had good to excellent results with a mean score of 94.3 (80–100). One patient had implant removal.
Conclusions
Percutaneous or mini-open transcortical crossing screws for isolated non-comminuted olecranon fractures offer a cheap, simple, and efficient mini-invasive stable fixation that allows early rehabilitation with excellent results and minimal complications. A comparative study with tension band wiring (TBW) and plating is recommended before standardization of the technique.