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Carminati F, Obert L, Saade F, Bouteille C, Woussen E, Aouzal Z, Bourgeois M, Haight H, Regas I, Rochet S, Lepage D, Garbuio P, Loisel F. Reproducibility of the Mayo and Schatzker classification systems in proximal ulna fractures. Orthop Traumatol Surg Res 2024; 110:103790. [PMID: 38070730 DOI: 10.1016/j.otsr.2023.103790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 04/29/2024]
Abstract
INTRODUCTION A fracture classification system should provide a reliable and reproducible means of communication between different parties. It should be logical and understandable, with few categories to memorize. The aim of this study was to determine the intra- and interobserver reliability of the Schatzker and Mayo classification systems for the assessment of proximal ulna fractures. MATERIALS AND METHODS Intra- and interobserver reliability studies were conducted on 39 X-rays of injured elbows drawn randomly from 74 cases previously used in a series on predictors of ulnohumeral osteoarthritis in proximal ulna fractures. Ten observers independently reviewed these X-rays on 2 separate occasions 3 months apart. The fracture type was assessed according to the Schatzker and Mayo classification systems during each reading session. Cohen's and Fleiss' kappa were used to measure the intra- and interobserver reliability. RESULTS The Schatzker classification had a fair interobserver reliability for the first (Schatzker R1, Fleiss' κ: 0.394) and second (Schatzker R2, Fleiss' κ: 0.351) readings. The mean intraobserver reliability value between the 10 reviewers for the Schatzker classification was rated as substantial (0.61). The Mayo classification had a fair interobserver reliability for the first (Mayo R1, Fleiss' κ: 0.278) and second (Mayo R2, Fleiss' κ: 0.292) readings. The mean intraobserver reliability value between the 10 reviewers for the Mayo classification was rated as fair (0.52). DISCUSSION The classification systems for proximal ulna fractures showed poor reproducibility between the different observers since they had low interobserver agreement values. Nevertheless, their use remained reliable since the measured intraobserver agreement value was deemed substantial. LEVEL OF EVIDENCE IV; retrospective.
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Affiliation(s)
- Fabio Carminati
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France.
| | - Laurent Obert
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - François Saade
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Camille Bouteille
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Edouard Woussen
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Zouhair Aouzal
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Michaël Bourgeois
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Harrison Haight
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Inès Regas
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Séverin Rochet
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Daniel Lepage
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - Patrick Garbuio
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
| | - François Loisel
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, hôpital Jean-Minjoz, 25030 Besançon, France
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Sobel AD, Babu JM, Blood TD, Paxton ES. Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model. J Hand Surg Am 2022; 47:796.e1-796.e6. [PMID: 35031124 DOI: 10.1016/j.jhsa.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes. A biomechanical comparison of DLP and PLP fixation would help to validate the use of DLPs in comminuted olecranon fractures. METHODS Seven matched pairs of cadaveric upper extremities were evaluated with quantitative computed tomography scans to evaluate bone mineral density (BMD). Osteotomies simulating comminuted olecranon fractures (Mayo Type IIB) were created and the specimens were fixed either with variable angle PLPs or variable angle DLPs. The specimens were then cyclically loaded and loaded to failure. The ultimate strength, fracture displacement, and mechanism of failure were recorded and compared across groups. The correlation between BMD and ultimate strength was analyzed. RESULTS The mean total BMD was 0.79 g/cm2 (SD, 0.14 g/cm2). No specimen failed during cyclic testing. Five of 7 PLP specimens and 5 of 7 DLP specimens failed by fracture through the proximal screws though in different planes (sagittal vs axial splits, respectively). The mean ultimate strengths of the PLP (1077 N [SD, 462 N]) and DLP (1241 N [SD, 506 N]) groups were similar. There was a linear relationship between ultimate strength and BMD (R2 = 0.33). CONCLUSION Dual locking plates display biomechanical properties that suggest that they can be used in the fixation of comminuted olecranon fractures. Catastrophic failure of the fixation constructs occurs around stress risers at the proximal screws rather than due to displacement at the fracture itself. CLINICAL RELEVANCE Dual locking plate constructs can be considered for use in the fixation of comminuted olecranon fractures.
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Affiliation(s)
- Andrew D Sobel
- Department of Orthopaedics, St. Luke's University Health Network, Bethlehem, PA; Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Jacob M Babu
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - Travis D Blood
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
| | - E Scott Paxton
- Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI
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Qi H, Li Z, Lu Y, Ma T, Ji S, Du B, Li M, Huang Q, Zhang K, Yang Y. Comparison of clinical outcomes of three internal fixation techniques in the treatment of olecranon fracture: a retrospective clinical study. BMC Musculoskelet Disord 2022; 23:521. [PMID: 35650582 PMCID: PMC9158155 DOI: 10.1186/s12891-022-05482-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The application of double plating in olecranon fractures is becoming increasingly widespread. There is no research comparing this technique with traditional tension band wiring (TBW) and the single plate technique. The purpose of this study was to compare the efficacy of three fixation techniques in olecranon fractures. MATERIALS AND METHODS From March 2016 to May 2020, we collected the clinical data of 95 patients with olecranon fractures who underwent surgical treatment. Thirty-five patients received TBW surgery (TBW Group), 32 patients received a 3.5 mm locking compression plate (LCP, 3.5 mm LCP Group), and 28 patients received double mini-locking plate treatment (DP Group). The operation time, fracture union time, time of return to work, range of motion (ROM), soft tissue stimulation to remove internal fixation, and patient-related functional results (the Weseley score, Mayo Elbow Performance Score [MEPS], and Disabilities of Arm, Shoulder and Hand Score [DASH]) were recorded. The clinical results and complications of the three internal fixation techniques were compared. RESULTS The average follow-up time was 15.011.82 months (12-18 months). All patients' fractures healed by first intention. There were no statistically significant differences in the operation time, fracture union time, ROM, Weseley score, MEPS or DASH scores of the three groups of patients. The postoperative return time for patients in the TBW group was 10.002.15 weeks, the 3.5 mm LCP group was 9.561.93 weeks, and the DP group was 8.432.38 weeks (P = 0.014); 12 patients in the TBW group required removal of plant due to soft tissue stimulation, the 3.5 mm LCP group had 8 cases, and the DP group had 2 cases (P = 0.038). CONCLUSION The postoperative clinical results and elbow joint function of patients with olecranon fractures fixed by tension band wiring, 3.5 mm LCP and double mini-locking plate are similar, which indicates that double-plate technology can be used as an alternative to the two groups of traditional techniques. In addition, double-plate technology also helps patients return to work earlier and has a lower incidence of soft tissue stimulation.
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Affiliation(s)
- Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China.
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China.
| | - Shuai Ji
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
| | - Bing Du
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
| | - Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yanling Yang
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
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Wagner FC, Jaeger M, Friebis C, Maier D, Ophoven C, Yilmaz T, Südkamp NP, Reising K. Low-profile double plating of unstable osteoporotic olecranon fractures: a biomechanical comparative study. J Shoulder Elbow Surg 2021; 30:1519-1526. [PMID: 33359398 DOI: 10.1016/j.jse.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND In the treatment of unstable olecranon fractures, anatomically preshaped locking plates exhibit superior biomechanical results compared with tension band wiring. However, posterior plating (PP) still is accompanied by high rates of plate removal because of soft-tissue irritation and discomfort. Meanwhile, low-profile plates precontoured for collateral double plating (DP) are available and enable muscular soft-tissue coverage combined with angular-stable fixation. The goal of this study was to biomechanically compare PP with collateral DP for osteosynthesis of unstable osteoporotic fractures. METHODS A comminuted displaced Mayo type IIB fracture was created in 8 osteoporotic pairs of fresh-frozen human cadaveric elbows. Pair-wise angular stable fixation was performed by either collateral DP or PP. Biomechanical testing was conducted as a pulling force to the triceps tendon in 90° of elbow flexion. Cyclical load changes between 10 and 300 N were applied at 4 Hz for 50,000 cycles. Afterward, the maximum load was raised by 0.02 N/cycle until construct failure, which was defined as displacement > 2 mm. Besides failure cycles and failure loads, modes of failure were analyzed. RESULTS Following DP, a median endurance of 65,370 cycles (range, 2-83,121 cycles) was recorded, which showed no significant difference compared with PP, with 69,311 cycles (range, 150-81,938 cycles) (P = .263). Failure load showed comparable results as well, with 601 N (range, 300-949 N) after DP and 663 N (range, 300-933 N) after PP (P = .237). All PP constructs and 3 of 8 DP constructs failed by proximal fragment cutout, whereas 5 of 8 DP constructs failed by bony triceps avulsion. CONCLUSION Angular-stable DP showed comparable biomechanical stability to PP in unstable osteoporotic olecranon fractures under high-cycle loading conditions. Failure due to bony triceps avulsion following DP requires further clinical and biomechanical investigation, for example, on suture augmentation or different screw configurations.
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Affiliation(s)
- Ferdinand C Wagner
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany.
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christof Friebis
- GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany; Department of Trauma Surgery, Asklepios Klinikum, Hamburg, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christian Ophoven
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tayfun Yilmaz
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; GERN Gewebeersatz, Regeneration & Neogenese (Tissue Replacement, Regeneration & Neogenesis), Faculty of Medicine, Department of Orthopedics and Trauma Surgery, Medical Center, Albert Ludwig University of Freiburg, Freiburg, Germany
| | - Kilian Reising
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany; Department of Trauma Surgery, Asklepios Klinikum, Hamburg, Germany
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Hoelscher-Doht S, Kladny AM, Paul MM, Eden L, Buesse M, Meffert RH. Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures. Arch Orthop Trauma Surg 2021; 141:245-251. [PMID: 32417960 PMCID: PMC7886832 DOI: 10.1007/s00402-020-03473-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Proximal ulna fractures are common in orthopaedic surgery. Comminuted fractures require a high primary stability by the osteosynthesis, to allow an early functional rehabilitation as fast as possible, to reduce long-term limitations of range of motion. Classical dorsal plating is related to wound healing problems due to the prominence of the implant. New low-profile double plates are available addressing the soft tissue problems by positioning the plates at the medial and lateral side. This study analysed whether, under high loading conditions, these new double plates provide an equivalent stability as compared to the rigid olecranon locking compression plate (LCP). MATERIALS AND METHODS In Sawbones, Mayo Type IIB fractures were simulated and stabilized by plate osteosyntheses: In group one, two low-profile plates were placed. In group two, a single dorsal plate (LCP) was used. The bones was than cyclically loaded simulating flexion grades of 0°, 30°, 60° and 90° of the elbow joint with increasing tension forces (150 , 150 , 300 and 500 N). The displacement and fracture gap movement were recorded. In the end, in load-to-failure tests, load at failure and mode of failure were determined. RESULTS No significant differences were found for the displacement and fracture gap widening during cyclic loading. Under maximum loading, the double plates revealed a comparable load at failure like the single dorsal plate (LCP). The double plates failed with a proximal screw pull-out of the plate, whereas in the LCP group, in 10 out of 12 specimens the mode of failure was a diaphyseal shaft fracture at the distal plate peak. CONCLUSION Biomechanically, the double plates are a good alternative to the dorsal LCP providing a high stability under high loading conditions and, at the same, time reducing the soft tissue irritation by a lateral plate position.
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Affiliation(s)
- Stefanie Hoelscher-Doht
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany.
| | - A-M Kladny
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - M M Paul
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - L Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
| | - M Buesse
- Institut Straumann AG, Peter-Merian-Weg 12, 4052, Basel, Switzerland
| | - R H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany
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Hopf JC, Nowak TE, Mehler D, Arand C, Gruszka D, Westphal R, Rommens PM. Nailing vs. plating in comminuted proximal ulna fractures - a biomechanical analysis. BMC Musculoskelet Disord 2020; 21:616. [PMID: 32943020 PMCID: PMC7495877 DOI: 10.1186/s12891-020-03637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating. Methods A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N – 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis. Results The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters. Conclusions Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.
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Affiliation(s)
- Johannes Christof Hopf
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tobias Eckhard Nowak
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dominik Gruszka
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ruben Westphal
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
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Savvidou OD, Koutsouradis P, Kaspiris A, Naar L, Chloros GD, Papagelopoulos PJ. Displaced olecranon fractures in the elderly: outcomes after non-operative treatment - a narrative review. EFORT Open Rev 2020; 5:391-397. [PMID: 32818066 PMCID: PMC7407865 DOI: 10.1302/2058-5241.5.190041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Operative treatment with tension band wiring or plate is the gold standard of care for displaced olecranon fractures. In elderly patients, multiple comorbidities combine with increased intraoperative risks, and postoperative complications may yield poor results. There are small series in the literature that show promising results with non-operative treatment. Non-operative treatment may provide reasonable function and satisfaction in the elderly population and could be considered as a treatment option in this group, especially for those with comorbidities, to avoid postoperative complications and the need for re-operation.
Cite this article: EFORT Open Rev 2020;5:391-397. DOI: 10.1302/2058-5241.5.190041
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Affiliation(s)
- Olga D Savvidou
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | | | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece
| | - Leon Naar
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | - George D Chloros
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, 'ATTIKON' University General Hospital, Athens, Hellenic Republic, Greece
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Ellwein A, Argiropoulos K, DeyHazra RO, Pastor MF, Smith T, Lill H. Clinical evaluation of double-plate osteosynthesis for olecranon fractures: A retrospective case-control study. Orthop Traumatol Surg Res 2019; 105:1601-1606. [PMID: 31668918 DOI: 10.1016/j.otsr.2019.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/02/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Single, dorsal plating is a commonly used technique for treating olecranon fractures. Double-plate osteosynthesis is an alternative treatment. Aim of this study was to present the surgical technique using this novel double-plate implant for olecranon fractures and review clinical results, complication rates and revision surgeries. Results were compared to single, dorsal plating. HYPOTHESIS Does double-plate osteosynthesis for olecranon fractures improve material's tolerance with respect to osteosynthesis by single dorsal plating? PATIENTS AND METHODS Between February 2011 and March 2015, we retrospectively evaluated 47 patients who were included in this study: 25 were treated with a low-profile double-plate osteosynthesis and 22 with an anatomically pre-shaped 3.5mm locking compression plate (LCP). The 2 groups were the result of a change of implants in our department in 2013. Patient satisfaction, range of motion, patient related outcome scores (Mayo Elbow Performance Score [MEPS], Disabilities of Arm, Shoulder and Hand Score [DASH]), complications and revision surgeries were evaluated. Results between both implant types were statistically compared using the Mann-Whitney U test. RESULTS After a mean follow-up of 41 months (range: 25-61), the low-profile double-plate group showed a range of motion of 127°, MEPS of 94 and DASH of 6. The 3.5mm LCP group was found to have a range of motion of 130°, MEPS of 96 and DASH of 8. No clinical difference was found between groups. A total of 9 revision surgeries after double-plate osteosynthesis were recorded including seven implant removals and two intraarticular screws. One loosening of a screw without revision surgery was reported. The 3.5mm LCP group had 9 revision surgeries including eight implant removals and one intraarticular screw. DISCUSSION Low-profile double-plate osteosynthesis is a safe and effective alternative treatment of olecranon fractures. Subjective and objective clinical outcome measures revealed a low complication rate and excellent results. Still, implant removal due to soft tissue irritation remains an issue. These findings were comparable to common dorsal plate osteosynthesis. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Alexander Ellwein
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany; Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstr 5, 30169 Hannover, Germany.
| | - Konstantinos Argiropoulos
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstr 5, 30169 Hannover, Germany
| | - Rony-Orijit DeyHazra
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstr 5, 30169 Hannover, Germany
| | - Marc-Frederic Pastor
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany
| | - Tomas Smith
- Department for Orthopaedic Surgery, Medical School Hannover, DIAKOVERE Annastift, Anna-von-Borries-Straße 1-7, 30625 Hannover, Germany
| | - Helmut Lill
- Department for Orthopaedic Surgery and Traumatology, DIAKOVERE Friederikenstift, Humboldtstr 5, 30169 Hannover, Germany
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Prospective comparative analysis of arthroscopic debridement for primary and post-traumatic elbow osteoarthritis. Orthop Traumatol Surg Res 2019; 105:S217-S220. [PMID: 31537494 DOI: 10.1016/j.otsr.2019.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/02/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The main aim of the present study was to compare the preoperative profiles and the efficacy of arthroscopic debridement for elbow osteoarthritis between patients with primary versus post-traumatic osteoarthritis. The study hypothesis was that the two groups would show no difference on either criterion. METHOD In the framework of a symposium of the French Arthroscopy Society (SFA), a prospective comparative multicenter study included 87 patients with 6 months' follow-up of arthroscopic debridement for elbow osteoarthritis: 53 primary (G1) and 34 secondary (G2). Pre- and post-operative clinical assessment in both groups compared Andrews-Carson specific functional score for elbow osteoarthritis (main endpoint), and the QuickDash (QD), Patient-Related Elbow Evaluation (PREE) and Mayo Elbow Performance Score (MEPS) functional scores, pain on VAS, range of motion (RoM) and strength. RESULTS Arthroscopic debridement significantly improved all functional scores at 6 months, notably including the specific Andrews-Carson score, which showed gain in both groups: 68.5±28.7 (range, -5 to 110) in G1 and 62.6±25.4 (18 to 110) in G2 (P=0.35). Pain decreased significantly in both groups, by 5.1±2.6 points (range, 10 to 1) in G1 and 4.4±2.7 points (range, 8.5 to 1) in G2 (P=0.28). RoM in flexion-extension improved comparably in both groups, by 42.9±22.1 (-15 to 105) in G1 and 49.3±24.5 (10 to 90) in G2 (P=0.22). Strength in flexion improved comparably, by 7.6±4.7kg (-2 to 17.5) in G1 and 6.1±4.8kg (-1 to 13) in G2 (P=0.23). DISCUSSION/CONCLUSION The study hypothesis was confirmed: there were no differences according to primary versus secondary osteoarthritis in preoperative profile or results. Elbow osteoarthritis entails mechanical impingement. Arthroscopic debridement gave good results independently of primary or post-traumatic etiology. LEVEL OF EVIDENCE III, prospective comparative observational multicenter cohort study.
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Hopf JC, Nowak TE, Mehler D, Arand C, Gruszka D, Rommens PM. Nailing of proximal ulna fractures: biomechanical comparison of a new locked nail with angular stable plating. Eur J Trauma Emerg Surg 2019; 47:795-802. [PMID: 31677007 DOI: 10.1007/s00068-019-01254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Proximal ulna fractures are common injuries and frequently treated with angular stable plating. This surgical option shows good functional results. Relevant drawbacks such as large soft tissue exposure, compromised blood supply of fracture fragments and disturbing osteosynthetic material are described. The aim of this study was to compare a new locked proximal ulna nail with angular stable plating in a biomechanical testing setup for extraarticular proximal ulna fractures. METHODS Ten pairs of sawbones with a Jupiter type IIB proximal ulna fracture (OTA 2U1A3.1) were tested after osteosynthesis with the mentioned implants in a servo-pneumatic testing machine. The testing setup simulates physiological joint motion (0°-90°) under cyclic loading (30-300 N). Primary stability and loosening of both constructs were quantified using micromotion video-analysis after 608 test cycles. RESULTS The micromotion analysis showed significantly higher primary stability of the locked nail (0.29 ± 0.13 mm) compared to the angular stable plate (0.97 ± 0.30 mm, p < 0.001). Both implants showed a low amount of loosening after completion of the test cycles. The construct with the locked nail (0.08 ± 0.06 mm) showed significantly lower dislocation of the fragments measured at the anterior cortex (plate 0.24 ± 0.13 mm, p < 0.001). CONCLUSION Nailing of proximal ulna fractures shows significantly higher primary stability and lower loosening compared to angular stable plating in our testing setup.
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Affiliation(s)
- Johannes Christof Hopf
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tobias Eckhard Nowak
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dorothea Mehler
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Charlotte Arand
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Dominik Gruszka
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Pol Maria Rommens
- Department of Orthopedics and Traumatology, University Medical Center, Langenbeckstraße 1, 55131, Mainz, Germany
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11
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Eden L, Frey SP, Gilbert F, Jordan MC, Fenwick A, Meffert RH. Anatomically shaped locking plates for radial head and olecranon fracture fixation in Monteggia-like lesions. Technol Health Care 2019; 28:193-201. [PMID: 31594272 DOI: 10.3233/thc-191812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Monteggia-like lesions are rare injuries. We retrospectively reviewed 40 consecutive patients with Monteggia-like lesions treated at a level I trauma center from 2009 to 2016. Clinical results were evaluated with a focus on the use of modern locking plates. OBJECTIVE AND METHODS Twenty-eight patients had Bado type II fractures, 11 had Bado type I, and 1 had Bado type III. All patients were treated by plate fixation of the ulna with a locking compression plate or double mini-plates. Fixation or replacement was performed for radial head fractures. We characterized all fractures and recorded the range of motion (ROM); 100-point visual analog scale (VAS) scores for pain and function; Disabilities of the Arm, Shoulder and Hand (DASH) score; and Mayo Elbow Performance Score (MEPS). A follow-up rate of 78% was reached at an average of 36 months (range, 12-95 months). RESULTS Stable fixation without recurrent instability was accomplished. The average ROM for flexion reached 130∘ with an extension deficit of 13∘. The sum of supination and pronation was 136∘. The VAS scores for pain and function were 20 and 75, respectively. The average MEPS and DASH scores were 84 and 28, respectively. Bado type I fractures had better outcomes for all variables, especially forearm rotation (p< 0.05). The complication rate was 22.5% and revision rate was 17.5%. CONCLUSION This fracture repair technique can safely achieve good and excellent outcomes in most cases and is partly superior to previously published techniques. However, Bado type II fractures still have a risk of poor results.
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Affiliation(s)
- Lars Eden
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Sönke P Frey
- Department of Orthopedics and Trauma Surgery, St. Josef-Hospital Bochum, Katholisches Klinikum Bochum, Ruhr-University Bochum, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Martin C Jordan
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
| | - Annabel Fenwick
- Department of Trauma Surgery, Klinikum Augsburg, Augsburg, Germany
| | - Rainer H Meffert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University, Wuerzburg, Germany
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Clinical and radiological evaluation of surgical management in olecranon fracture-dislocations. Musculoskelet Surg 2019; 104:321-328. [PMID: 31583519 DOI: 10.1007/s12306-019-00623-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The treatment of olecranon fracture-dislocations (OFDs) remains challenging. OFDs are often misdiagnosed as Monteggia lesions, and the real frequency is actually higher. However, studies on OFDs are limited. This study aimed to report on the surgical management of OFDs and to highlight the importance of three-dimensional computed tomography (3D CT) evaluation in the treatment of OFDs. MATERIALS AND METHODS The study participants included 18 patients (11 men, 7 women, mean age 44 years (range 24-78) with OFDs. Each patient's medical records, radiographs, and 3D CT scans were reviewed for demographics, injury details, operative findings, and information about radiological and functional outcomes. The patients were divided into 2 groups according to the direction of the dislocation: the posterior dislocation group (group 1, 7 patients) and anterior dislocation group (group 2, 11 patients). The clinical evaluation was performed according to Broberg-Morrey and the American Shoulder and Elbow Surgeons-Elbow (ASES-E) scoring systems. RESULTS The mean follow-up period was 39 months (range 25-62 months). The Broberg-Morrey results were excellent in 4, good in 9, fair in 3, and poor in 2 patients. The mean ASES-E score was 84.83 (range 48-100) points. There were signs of ulna-humeral arthrosis in 5 elbows. Arthrosis was graded as grade 1, grade 2, and grade 3 in 3, 1, and 1 elbows, respectively. Partial sensory recovery was observed in one patient with postoperative ulnar neuropathy at the last follow-up visit. CONCLUSIONS OFDs are complex injuries of the proximal ulna and may involve the radial head, coronoid process, and lateral collateral ligament. The effective treatment of OFDs begins with the proper identification of the injury with 3D CT. A secure fixation including the coronoid process is mandatory for the elbow joint stability. Insufficient restoration of the trochlear notch may lead to problems with loss of motion and arthrosis. Although an application of a pre-contoured locking anatomical olecranon plate can simplify the fixation procedure in most cases, the surgeons' equipment should also include radial head implant, coronoid plates, headless screws, small cannulated screw system, suture anchors, fluoroscopy, and articulated external fixator.
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Sun L, Li Z, Ma T, Xue HZ, Wang Q, Lu DG, Lu Y, Ren C, Li M, Zhang K. Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients. J Int Med Res 2019; 47:1998-2010. [PMID: 30880524 PMCID: PMC6567751 DOI: 10.1177/0300060518814607] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of the treatment of atrophic nonunion using structural autogenous ilium bone grafting in combination with vertical fixation of double plates. METHODS This retrospective study analysed the clinical data from consecutive patients with atrophic nonunion who underwent autogenous ilium grafting in combination with double-plate vertical fixation. The injury type and the bone affected by nonunion, the duration of nonunion and the outcomes following surgery were recorded for all patients. RESULTS The study enrolled 43 patients with atrophic nonunion of the upper and lower limbs: 17 patients with tibial nonunion, 21 with femoral nonunion, four with humeral nonunion and one with radial shaft nonunion. The mean duration of postoperative follow-up was 14.5 months (range, 8-28 months). A total of 43 of 43 patients (100%) achieved a healed nonunion fracture without the occurrence of complications such as infection, fracture of internal fixation or pain in the harvesting site. Comprehensive postoperative assessments of bone healing and function were observed to be good and/or excellent in all 43 patients. CONCLUSION Structural autogenous ilium grafting used in combination with double-plate vertical fixation can provide a stable structural environment for near optimal bone healing in patients with atrophic nonunion.
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Affiliation(s)
- Liang Sun
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Zhong Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Teng Ma
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Han-Zhong Xue
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Qian Wang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Dai-Gang Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Yao Lu
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Cheng Ren
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Ming Li
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
| | - Kun Zhang
- Department of Orthopaedic Surgery, Hong Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi Province, China
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Klug A, Gramlich Y, Buckup J, Wincheringer D, Hoffmann R, Schmidt-Horlohé K. Excellent results and low complication rate for anatomic polyaxial locking plates in comminuted proximal ulna fractures. J Shoulder Elbow Surg 2018; 27:2198-2206. [PMID: 30006238 DOI: 10.1016/j.jse.2018.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/14/2018] [Accepted: 05/21/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comminuted fractures of the proximal ulna remain a great challenge in orthopedic surgery. The purpose of this study was to report the outcomes of comminuted proximal ulna fractures treated with a new construct type-anatomically preformed polyaxial locking compression plates. METHODS Between 2013 and 2016, 46 patients with isolated comminuted fractures were treated with a 2.7-/3.5-mm VA-LCP Olecranon Plate (Synthes, Umkirch, Germany). Of these, 44 were available for an assessment after a mean follow-up period of 2.5 years (range, 12-50 months). We evaluated range of motion, time to recovery, revision rate, and indications, as well as functional scores. Radiographs were analyzed. RESULTS The study included 8 Mayo IB, 29 Mayo IIB, and 7 Mayo IIIB fractures. All fractures showed bony union, and only 2 revision surgical procedures were performed because of a new trauma. No other complications occurred. Mean range of motion was 139° (range, 105°-150°), and the mean pain level was less than 1 on a visual analog scale. Regarding elbow function, we found a mean Mayo Elbow Performance Score of 98; a mean Oxford Elbow Score of 44; and a mean Disabilities of the Arm, Shoulder and Hand score of 6. Of the plates, 41% were removed after an average time of 16 months, whereby a significant improvement in extension deficit was detected (P < .01). Ninety-five percent of all patients returned to their pretrauma sports level. CONCLUSION The 2.7-/3.5-mm VA-LCP Olecranon Plate represents an effective option with excellent fracture reduction, sufficient stability for early postoperative functional rehabilitation, and a minimum of complications.
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Affiliation(s)
- Alexander Klug
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany.
| | - Yves Gramlich
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Johannes Buckup
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Dennis Wincheringer
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Zentrum für Unfallchirurgie und Orthopädische Chirurgie, Frankfurt am Main, Germany
| | - Kay Schmidt-Horlohé
- Orthopaedicum Wiesbaden-Praxis für Orthopädie, Unfallchirurgie und Sportmedizin, Zentrum für Ellenbogenchirurgie, Wiesbaden, Germany
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16
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Hackl M, Mayer K, Weber M, Staat M, van Riet R, Burkhart KJ, Müller LP, Wegmann K. Plate Osteosynthesis of Proximal Ulna Fractures-A Biomechanical Micromotion Analysis. J Hand Surg Am 2017; 42:834.e1-834.e7. [PMID: 28606433 DOI: 10.1016/j.jhsa.2017.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 04/25/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Double plating has been promoted, in recent years, as an alternative treatment method for proximal ulna fractures. This study aimed to compare the biomechanical properties of double-plate osteosynthesis with posterior plate fixation using a novel investigational design utilizing a 3-dimensional camera system to analyze fracture micromotion. METHODS Fourteen fresh-frozen specimens were available for this study. Mayo type IIA fractures of the olecranon were created and internal fixation was performed with either an angular stable posterior plate or angular stable double plates. Fracture micromotion was evaluated by means of digital image correlation with a 3-dimensional camera system before and after dynamic cyclic loading from 15° to 90° of elbow flexion with a pulling force of 25 N to 80 N. RESULTS Micromotion of fragments was less pronounced in double-plate osteosynthesis when compared with single plates before and after cyclic loading. However, overall results were similar. Two of the single plates failed during cyclic loading but there were no failures in the double plates. CONCLUSIONS This biomechanical analysis shows that single and double plating results in comparable stability of fixation. Although the double-plating technique tends to provide more stable fixation, relevant differences were not observed. CLINICAL RELEVANCE Double plating potentially represents an efficient option for fixation of proximal ulna fractures. It could decrease the risk of soft tissue complications owing to their low profile and the superior soft tissue coverage.
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Affiliation(s)
- Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany; Institute of Anatomy I, University of Cologne, Cologne, Germany.
| | - Katharina Mayer
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Mareike Weber
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Manfred Staat
- Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - Roger van Riet
- Department of Orthopedic Surgery, Monica Hospital, Antwerp, Belgium
| | | | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, Cologne, Germany
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Lenich A, Imhoff AB, Siebenlist S. [Post-traumatic osteoarthritis of the elbow joint : Endoprosthetic options in young patients]. DER ORTHOPADE 2016; 45:844-52. [PMID: 27647165 DOI: 10.1007/s00132-016-3328-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In young patients, post-traumatic osteoarthritis of the elbow is a rare condition. Whereas clinical manifestations often differ from radiological findings, pain and stiffness are variably combined in symptomatic forms. In deciding whether to perform surgery, the patient's age, activity level, and symptoms, as well as the location and severity of the osteoarthritis have to be taken into account. Elbow joint instability has to be identified to stop the post-traumatic osteoarthritic progress. If joint preserving surgical methods fail, diverse options for partial or total joint replacement are available. THERAPY The treatment goal in young patients, therefore, is to reduce pain with a sufficient range of elbow motion.
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Affiliation(s)
- A Lenich
- Orthopädie, Unfall-, Handchirurgie und Sportorthopädie, Helios Klinikum München West, Steinerweg 5, 81245, München, Deutschland.
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
| | - S Siebenlist
- Abteilung und Poliklinik für Sportorthopädie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
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18
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Reconstruction of Monteggia-like proximal ulna fractures using different fixation devices: A biomechanical study. Injury 2016; 47:1636-41. [PMID: 27242331 DOI: 10.1016/j.injury.2016.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/02/2016] [Accepted: 05/09/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Comminuted proximal ulna fractures are rare and reconstruction of these fractures is discussed controversially. The aim of this study was to test three currently available plate devices in a standardized comminuted four-part fracture model created in proximal ulna sawbones. MATERIAL AND METHODS A standardized four-part fracture of the proximal ulna was created in 80 sawbones. Reconstruction was performed by five experienced test surgeons according to a standardized reconstruction protocol. Each surgeon reconstructed 4 fractures with a 3.5mm eight-hole reconstruction plate, 4 fractures with seven-hole third-tubular double plates and 4 fractures with a 3.5mm anatomical seven-hole locked angle proximal ulna plate. 4 more fractures were reconstructed with simple K-wires as a reference construct for further experiments. Outcome measurements were time for reconstruction, quality of reconstruction and stability of the reconstruction. Stability testing was done in 90° and 30° flexion of the elbow. Testing in 30° flexion was done to test the anteroposterior stability regarding the fixed coronoid process. RESULTS Time for reconstruction was significantly less for K-wire fixation than for the plate devices. Time for reconstruction plating and locked angle plating was significantly lower than for double plating (p<0.005). Quality of reduction did not differ between the three plate systems (p<0.05). K-wire fixation showed the best quality of reduction (p<0.005). In 90° of elbow flexion the anatomic locked angle olecranon plate showed a significantly higher stability compared to the other devices. Furthermore the tubular double plating was significantly more stable than reconstruction plating or K-wire fixation (p<0.05). In anteroposterior loading at 30°, the stability did not differ between the 4 different fixation techniques (p>0.05). For all devices the testing in 30° flexion showed a significantly higher rigidity compared to 90° flexion. CONCLUSION The locked angle plate system showed the highest stability in 90° of elbow flexion. Each implant was more stable in 30° flexion than in 90° flexion. Testing of the anterior stability of the elbow did not show any differences between the different implants. Because of the superior stability of this device, we conclude that locked angle plating should be preferred for reconstruction of monteggia like complex proximal ulna fractures.
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Koslowsky TC, Berger V, Hopf JC, Müller LP. Presentation of the vascular supply of the proximal ulna using a sequential plastination technique. Surg Radiol Anat 2015; 37:749-55. [PMID: 25894529 DOI: 10.1007/s00276-015-1476-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to demonstrate the peri- and intraosseous vascular supply of the proximal ulna. METHODS Eleven fresh human cadaveric elbows were sequentially plastinated beginning with arterial injection, followed by block and secondary slice plastination of the whole elbow. With this technique, we obtained completely transparent cadaveric slices in which the peri- and intraosseous vascular architecture could be studied. RESULTS Proximal ulna vascularization is due to an arterial network: a superior and inferior collateral ulnar artery and the profunda brachial artery climbing to the olecranon from proximal. An anterior artery and a posterior recurrent artery climb up distally to the medial parts of the ulna and an interosseous recurrent artery is responsible for the lateral and posterolateral proximal part of the ulna. The intraosseous vascularization is due to directly penetrating branches out of the posterior recurrent ulnar artery and a vascular plexus at the olecranon tip. In addition, we saw a major distal bone penetration branch coming from the recurrent posterior artery, climbing intraosseously without junction to the proximal penetrating branches. CONCLUSION The peri- and intraosseous vascularization of the proximal ulna was shown. A transitional zone of the intraosseous vascularization of the proximal ulna was detected.
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Affiliation(s)
- Thomas C Koslowsky
- Chirurgische Klinik, St. Elisabeth Krankenhaus, Werthmannstrasse 1, 50935, Cologne, Germany,
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Niglis L, Bonnomet F, Schenck B, Brinkert D, Di Marco A, Adam P, Ehlinger M. Critical analysis of olecranon fracture management by pre-contoured locking plates. Orthop Traumatol Surg Res 2015; 101:201-7. [PMID: 25736196 DOI: 10.1016/j.otsr.2014.09.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/19/2014] [Accepted: 09/29/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fractures of the proximal ulna are rare and usually managed surgically. Strong fixation of the harware is essential to obtain good outcomes. We report our experience with pre-contoured locking plate fixation of complex olecranon fractures and present a critical appraisal of the outcomes. HYPOTHESIS Pre-contoured locking plates provide good outcomes, but their clinical tolerance may be limited in some instances. MATERIALS AND METHODS From September 2009 to December 2011, 28 patients were managed using a pre-contoured locking compression plate (LCP(®)). Among them, 6 were excluded because of missing data, which left 22 patients (11 males and 11 females) with a mean age of 55.7 years, including 12 who were employed. The fracture was on the dominant side in 11 patients. According to the Mayo Clinic classification, 15 fractures were type II and 7 type III. In addition to the ulnar fracture, a radial head fracture was present in 9 patients and a coronoid process fracture in 5 patients. Functional recovery was assessed using the Broberg-Morrey score and Mayo Elbow Performance Score (MEPS). Radiographs were obtained to evaluate the quality of fracture reduction and fracture healing, as well as to look for ossifications and osteoarthritis. RESULTS Mean follow-up was 20 months. Flexion was 131°, extension loss was 9.5°, pronation was 79°, and supination was 80.5°. The mean Broberg-Morrey score was 96.7 and the mean MEPS score 96.6. Fracture healing occurred in all patients, within a mean of 10.6 weeks. Evidence of early osteoarthritis was found in 6 patients, ossifications in 3 patients, and synostosis in 1 patient. An infection was successfully treated with lavage and antibiotic therapy in 1 patient. The fixation hardware was removed in 6 patients. No prognostic factors were identified. DISCUSSION-CONCLUSION Our hypothesis was confirmed. The outcomes are encouraging and comparable to those reported in the literature. The critical issue is the limited clinical tolerance of the plate with a high rate of posterior impingement requiring plate removal (27%). Rigorous technique is essential during plate implantation. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- L Niglis
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - F Bonnomet
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Schenck
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - D Brinkert
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - A Di Marco
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - P Adam
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, CHU Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Post-traumatic osteoarthritis of the elbow. Orthop Traumatol Surg Res 2014; 100:S15-24. [PMID: 24461231 DOI: 10.1016/j.otsr.2013.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 02/02/2023]
Abstract
Post-traumatic osteoarthritis of the elbow is an uncommon condition in which the clinical manifestations are often at variance with the radiological findings. In symptomatic forms, pain and stiffness are variably combined. When non-operative management fails, the decision to perform surgery is taken on a case-by-case basis depending on age, activity level, patient discomfort, and osteoarthritis location and severity as assessed by CT scan arthrography. Elbow instability or subluxation should be sought. Post-traumatic elbow osteoarthritis raises difficult therapeutic problems in young patients. The goal of treatment is to obtain a low level of pain with sufficient motion range to ensure good function, while preserving future surgical options and delaying elbow arthroplasty to the extent possible.
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