External fixation for open proximal ulnar fractures

Use of Ilizarov Fixator for Grade III B Open Olecranon Fracture: a Case Report and Surgical Technique

Introduction:

External fixator application can be difficult for olecranon fractures in presence of large degloving injuries. We describe use of simple Ilizarov ring fixator construct for grade IIIB open olecranon fracture management.

Case Report:

A 45-year-old female with Grade III B open comminuted olecranon fracture (30*15cm degloving area) and ulnar nerve palsy was treated with a novel ring fixator construct. Two cut-end olive wires were passed from the proximal olecranon across the fracture site in intramedullary fashion exiting dorsally at mid-ulnar level through healthy skin and were attached to an Ilizarov half ring secured by perpendicular wires. The olive wires were tensioned, achieving compression and stability. Range of motion (ROM) exercises could be started quickly as the elbow was not spanned. Wound healed after skin grafting and at one-year follow-up the patient has good functional results (PRE 7, DASH 9.48), elbow ROM 10°-130°, 75° pronation and 85° supination. The patient returned to pre-injury occupational activities and had no pain. At three-year follow-up, the x-ray and CT showed union of olecranon fragment with well-maintained congruency.

Conclusion:

Internal fixation in most cases may be precluded by the soft tissue trauma and risk of infection. In addition, the small proximal fragment precludes a stable external fixation. In this technique, the hardware is kept away from the open wound allowing better wound inspection and care. The intramedullary olive wires provide compression and stability, and thus allow early ROM. Ilizarov half-ring and olive wire fixation can be an useful option for management of high grade open olecranon fractures because of its advantages, viz. stable fixation, minimal internal hardware, optimal wound care, immediate initiation of range of motion, and good outcome.

Management of open olecranon fractures using clamp-cum-compressor device

BACKGROUND

Open fractures of olecranon are not a rare occurrence in patients with road traffic accidents particularly motor bike riders who don't use elbow guards. Definitive treatment has to be delayed in many till the wound heals. The present study was conducted to evaluate the results of open fractures of olecranon using clamp-cum-compressor device.

MATERIALS AND METHODS

Seventeen patients between the ages of 20 and 45 years of open olecranon fractures reported 5-20 days after injury were treated using an indigenous clamp-cum-compressor. All fractures were Mayo type II-A, i.e., displaced, stable and noncomminuted. Four patients had Gustilo-Anderson grade I and 13 had Gustilo-Anderson grade II open fractures. The patients with transverse or short oblique fractures were included in the study. The apparatus was applied under regional anesthesia after thorough washing and debridement of wounds with few loose sutures applied wherever needed. The wounds healed within 2-4 weeks and fractures united within 8-10 weeks. The elbow was mobilized with apparatus still in place. The results were evaluated by MayoElbow performance score.

RESULTS

We achieved excellent results in twelve patients, good in four and poor in one patient, who reported late, hooks of the apparatus were cut through the proximal fragment, leading to union of fracture in elongation and restricted elbow movements.

CONCLUSION

The apparatus was found to be quite useful in transverse and short oblique fractures with contamination or infection, where internal fixation has to be delayed or avoided.

Proximal Radio-Ulnar Synostosis at the Pin-Track Site after External Fixation of the Forearm

Posttraumatic synostosis of the forearm bones is a rare but serious complication following fixation or even conservative treatment of adult forearm fractures. This is the second report in the English literature of such a complication at the pin-track site following external fixation of proximal forearm fractures. A 36-year-old male patient sustained an open fracture of his proximal right forearm after a road traffic accident. It was managed by external fixation of the ulna and plate fixation of the radius. At follow-up, a type 3 radio-ulnar synostosis at the pin-track site became evident, which was treated after 20 months with surgical resection of the bony bridge to regain the rotatory motion of his forearm.