Olecranon Stress Fracture

Non-Medial Ulnar Collateral Ligament Elbow Pathology in the Thrower: Valgus Extension Overload, Osteochondritis Dissecans, Olecranon Stress Fracture, and Ulnar Nerve

Injury rates in baseball players reach as high as 5.8 per 1000 at the professional level. Recent data have singled out the elbow as the leading cause of injured list necessitating injuries and the costliest injury location in professional baseball. While the medial ulnar collateral ligament (MUCL) has gained the largest notoriety in this population, elbow injury in the thrower occurs as a spectrum of pathologies. These pathologies may encompass other injuries often resulting from or occurring in conjunction with MUCL insufficiency. These conditions include valgus extension overload syndrome, osteochondritis dissecans, olecranon stress fractures, and ulnar nerve pathology.

Upper Extremity Stress Fractures

BACKGROUND

Stress injuries are often missed secondary to their insidious onset, milder symptoms, and subtle or initially absent findings when imaged.

MAIN BODY

This review aims to provide strategies for evaluating and treating upper extremity stress fractures. This article outlines the classic presentation of each fracture, the ages during which these injuries often occur, the relevant anatomy and biomechanics, and the mechanism of each injury. Diagnostic imaging and management principles are also discussed, including the use of conservative versus surgical management techniques.

SHORT CONCLUSION

Upper extremity stress fractures are often mild injuries that resolve with conservative management but can lead to more serious consequences if ignored. Given their increasing incidence, familiarity with diagnosis and management of these injuries is becoming increasingly pertinent.

Influence of oblique proximal ulnar osteotomy on humeral intracondylar fissures in 35 spaniel breed dogs

OBJECTIVE

To investigate the effects of oblique proximal ulnar osteotomy (PUO) on the healing of humeral intracondylar fissure (HIF) in spaniel breed dogs.

STUDY DESIGN

Clinical retrospective study.

SAMPLE POPULATION

A total of 51 elbows from 35 spaniel dogs.

METHODS

An oblique PUO was performed in dogs diagnosed with HIF. The degree of healing of HIF was subjectively and objectively assessed on preoperative and long-term follow-up CT imaging. Objective assessment was performed by measuring the bone density in Hounsfield units (HU) of a rectangular region of interest (ROI) encompassing the entire hypoattenuated humeral fissure. Major and minor complications were recorded.

RESULTS

A total of 24 partial and 27 complete HIFs were diagnosed. The follow-up CT scan was performed at a median 18.5 months (range 10-49 months). Subjective assessment confirmed partial or complete healing of the HIF in 41 elbows (80.3%). Objective assessment confirmed a difference in mean HU of the HIF's ROI between preoperative (HU 640) and last follow-up CT images (HU 835) (p = .001). Young dogs (<14 months) had the highest increase in HU of the HIF's ROI. Major complications occurred in five dogs (6 limbs) of which four were related to the lack of healing of the fissure (7.8%).

CONCLUSION

Oblique PUO resulted in partial or complete healing of HIF and pain resolution in the majority of dogs.

CLINICAL SIGNIFICANCE

This study introduces an innovative approach to achieve healing of the HIF in the dog, which may help reduce the high complication rate traditionally associated with the use of transcondylar screws.

Retrograde headless compression screw fixation of olecranon stress fractures in throwing athletes: a novel technique

Background

An olecranon stress fracture (OSF) is a rare injury most commonly seen in high-level overhead throwing athletes with no clear consensus on surgical treatment. The most common surgical treatment described in the literature is cannulated screw fixation but there have been high rates of reported hardware irritation and need for subsequent hardware removal.

Hypothesis/Purpose

This study describes a novel surgical technique in the treatment of OSFs in high-level throwing athletes using retrograde headless compression screws. We hypothesized that patients would have excellent outcomes and decreased rates of hardware irritation postoperatively.

Methods

A retrospective review of competitive-level throwing athletes who sustained OSFs that were treated operatively using a novel technique using retrograde cannulated headless compression screws to avoid disruption of the triceps tendon. Postoperative outcome measures obtained included the Disabilities of the Arm, Shoulder and Hand score, Mayo Elbow Performance Score, Simple Elbow Test score, Single Assessment Numerical Evaluation score, Visual Analog Scale, arch of motion, and time to return to sport as well as level returned to. Radiographs were obtained routinely at 2-week, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up.

Results

Five of 5 patients who met inclusion criteria were available for final follow-up. Mean age at time of surgery was 20 years (range 17-24). Mean follow-up was 17 months (range 4-33). All patients were baseball players, 4 of which were pitchers and 1 position player. All patients were able to return to sport at the same level or higher at a mean of 5.8 months (range 3-8). Postoperatively, mean arch of motion was 138°, Visual Analog Scale score was 0, Single Assessment Numerical Evaluation score was 90, Disabilities of the Arm, Shoulder and Hand score was 2.0, Mayo Elbow Performance Score was 100, and Simple Elbow Test score was 12. There was no incidence of hardware removal.

Conclusion

This study presents a novel surgical technique in the treatment of OSFs in high-level throwing athletes. The results presented demonstrate that this technique is safe and effective for getting athletes back to play quickly without any complications of hardware irritation which has previously shown to be a significant problem in prior literature.

Olecranon Fractures: A Critical Analysis Review

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Olecranon fractures account for 10% of all elbow fractures and are more likely to result from a low-energy injury. A displaced fracture with a stable ulnohumeral joint (Mayo type 2) is the most common type of injury.

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The management of an isolated olecranon fracture is based on patient factors (age, functional demand, and if medically fit to undergo surgery) and fracture characteristics including displacement, fragmentation, and elbow stability.

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Nonoperative management can be successfully used in undisplaced fractures (Mayo type 1) and in displaced fractures (Mayo type 2) in frail patients with lower functional demands.

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Patients with displaced olecranon fractures with a stable ulnohumeral joint without significant articular surface fragmentation (Mayo type 2A) can be managed with tension band wiring, plate osteosynthesis (PO), intramedullary fixation, or suture repair.

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PO is advocated for multifragmentary fractures and fractures that are associated with ulnohumeral instability. It is essential to consider the variable anatomy of the proximal ulna during surgery.