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Calisal E, Uğur L. Olecranon fractures: A biomechanical comparison of three tension band wiring fixation methods on bone models. J Orthop Surg (Hong Kong) 2023; 31:10225536231223109. [PMID: 38115708 DOI: 10.1177/10225536231223109] [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] [Indexed: 12/21/2023] Open
Abstract
PURPOSE This study aimed to compare the biomechanical pull-out strength of the three different tension band wiring (TBW) methods employed to fix transverse olecranon fractures on bone models. METHODS Three different fixation models were created in groups of seven synthetic olecranon fractured bone models. The first technique was fixed the olecranon with the traditional TBW method. The second technique was fixed the olecranon with a large intramedullary screw TBW method. The third technique was fixed the olecranon with the double-screw TBW method. The pull-out force needed for the failure of each specimen under the tensile test device was evaluated, and the results were recorded. RESULTS We found that the lowest average pull out strength was 55.10 N (range: 35.87-65.85 ± 10.17) in the traditional TBW method, the highest pull out strength was 84.28 N (range: 63.67-117 ± 18.87) in the double-screw TBW method. The pull out strength was 70.80 N (range: 52.60-80.95 ± 10.18) in the intramedullary screw TBW method. In terms of ultimate failure loads, there was no significant difference between the intramedullary screw TBW and the double-screw TBW (p > .05) while there was a significant difference between the traditional TBW and the other two methods (p < .05). CONCLUSION The use of screw(s) shows higher biomechanical stability than K-wires in the TBW method. Double-screws fixation gives similar results in terms of the biomechanical load to failure compared to a large intramedullary screw fixation. Both screw methods can be used as stable constructs in clinical practice. LEVEL OF EVIDENCE III, biomechanical trial.
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Affiliation(s)
- Emre Calisal
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Levent Uğur
- Department of Mechanical Engineering, Faculty of Engineering, Amasya University, Amasya, Turkey
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Duckworth AD, Carter TH, Chen MJ, Gardner MJ, Watts AC. Olecranon fractures : current treatment concepts. Bone Joint J 2023; 105-B:112-123. [PMID: 36722062 DOI: 10.1302/0301-620x.105b2.bjj-2022-0703.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite being one of the most common injuries around the elbow, the optimal treatment of olecranon fractures is far from established and stimulates debate among both general orthopaedic trauma surgeons and upper limb specialists. It is almost universally accepted that stable non-displaced fractures can be safely treated nonoperatively with minimal specialist input. Internal fixation is recommended for the vast majority of displaced fractures, with a range of techniques and implants to choose from. However, there is concern regarding the complication rates, largely related to symptomatic metalwork resulting in high rates of implant removal. As the number of elderly patients sustaining these injuries increases, we are becoming more aware of the issues associated with fixation in osteoporotic bone and the often fragile soft-tissue envelope in this group. Given this, there is evidence to support an increasing role for nonoperative management in this high-risk demographic group, even in those presenting with displaced and/or multifragmentary fracture patterns. This review summarizes the available literature to date, focusing predominantly on the management techniques and available implants for stable fractures of the olecranon. It also offers some insights into the potential avenues for future research, in the hope of addressing some of the pertinent questions that remain unanswered.Cite this article: Bone Joint J 2023;105-B(2):112-123.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Thomas H Carter
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - Michael J Chen
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Centre, Stanford, California, USA
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wrightington, UK
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Shimura H, Nimura A, Fujita K, Kaburagi H. Comparison of the efficacy of the tension band wiring with eyelet wire versus anatomical locking plate fixation for the treatment of displaced olecranon fractures. J Orthop Surg (Hong Kong) 2022; 29:23094990211059231. [PMID: 34872400 DOI: 10.1177/23094990211059231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This retrospective study was conducted to assess the clinical outcome and complications between tension band wiring (TBW) with eyelet wire and locking plate fixation used for the treatment of displaced olecranon fractures. METHODS A total of 58 patients (36 males and 22 females; mean age: 63 years) were reviewed between April 2014 and September 2020. TBW with Ring Pin (RP group) was applied in 24 patients, including 15 Mayo type ⅡA and 9 Mayo type ⅡB patients. Anatomical locking plate (ALP group) was used in 34 patients, including 22 Mayo type ⅡA and 12 Mayo type ⅡB patients. Clinical outcome was evaluated using the Mayo Elbow Performance Score (MEPS), and active range of motion of the elbow and forearm and postoperative complications were reviewed. RESULTS General characteristic of the patients and the fracture type were similar in the two groups. The mean MEPS values were 96.5 ± 7.3 in the RP group and 94.9 ± 9.4 in the ALP group. The mean elbow flexion arc was 127°±11 in the RP group. The mean elbow flexion arc was 122°±18 in the ALP group. No significant differences in clinical outcomes were observed between the two groups. Complication rates were significantly higher in the ALP group (19/34: 56%) than in the RP group (6/24: 25%). CONCLUSION Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group.
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Affiliation(s)
- Haruhiko Shimura
- Department of Orthopedic Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Japan
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Tsujino S, Tsujino A, Matsubara M. Tension-band wiring of displaced stable olecranon fractures with Eyelet-pins in the elderly: A series of 17 cases. Orthop Traumatol Surg Res 2021; 107:103076. [PMID: 34563734 DOI: 10.1016/j.otsr.2021.103076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/16/2021] [Accepted: 07/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tension-band wiring (TBW) and plate fixation are commonly used to fix displaced olecranon fractures. However, the high incidence of complications in the elderly, such as wound breakdown, infection, and loss of reduction, remain a concern for orthopaedic surgeons. Furthermore, patients frequently suffer from removal of the hardware. Even so, the operation seems to be indicated for independent elderly patients to return to their former activities of daily living. HYPOTHESIS TBW of displaced stable olecranon fractures with Eyelet-pins in the independent elderly reduce the incidence of complications and allow early elbow joint exercise to keep their former activities. PATIENTS AND METHODS We operated on the displaced stable olecranon fractures of 17 independent patients aged ≥ 70 using TBW with two Eyelet-pins. Eyelet-pins have an eyelet at the trailing end to prevent pin migration by passing a soft wire through it. The patients were reviewed clinically and radiologically at 2, 6, 12, and 24 weeks, and clinically at 1 year after the surgery. RESULTS All fractures were united within 12 weeks, and the anatomic reduction was maintained. Mean radiographic proximal migration of the Eyelet-pins was 0.4mm (0.1 ∼ 1.2mm). Mean active elbow flexion was 136° (115° ∼ 145°) and extension 6.2° (0° ∼ 30°). Two patients had mild local pain and pain on motion at the tip of the eyelet. No patient required removal of the hardware. Other complications, such as superficial or deep wound infections, and neurological symptoms or signs, were not seen. All patients were able to maintain their former activities of daily living. CONCLUSION TBW with Eyelet-pins for displaced stable olecranon fractures is useful for independent elderly patients to reduce the incidence of complications and to maintain their former activities of daily living without removal of the hardware. LEVEL OF EVIDENCE IV; single-centre retrospective study.
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Affiliation(s)
- Shohei Tsujino
- Department of Orthopaedic Surgery, Tamagawa Hospital, Setagaya, Tokyo, Japan; Miraidaira Orthopaedic Clinic, Tsukubamirai, Japan.
| | | | - Masaaki Matsubara
- Department of Orthopaedic Surgery, Tamagawa Hospital, Setagaya, Tokyo, Japan
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Meldrum A, Kwong C, Archibold K, Cinats D, Schneider P. Olecranon Osteotomy Implant Removal Rates and Associated Complications. J Orthop Trauma 2021; 35:265-270. [PMID: 33086235 DOI: 10.1097/bot.0000000000001979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study reports on olecranon osteotomy implant removal rates, fixation types, and associated complications. DESIGN Multicentre case series. SETTING Patients were identified through an electronic medical database at one Level 1 trauma center and three Level 2 trauma centers. PATIENTS Two hundred thirty-five patients were identified through the database, of which 92 patients met inclusion criteria. INTERVENTION Patients underwent olecranon osteotomy for fixation of distal humerus fractures and the implant used was at the surgeon's discretion. MAIN OUTCOME MEASUREMENT Implant removal rate. RESULTS Thirty-four of 92 (37.0%) patients underwent removal of implant from their olecranon osteotomy. Implant removal rates were as follows: 28 of the 63 patients for tension band wiring (TBW) (44.4%), 6 of the 18 patients for plates (33.3%), 0 of the 1 patient for cable-pin, and 0 of the 10 patients for osteotomies fixed with a screw fixation. Screw fixation was removed less frequently than TBW (P = 0.01). Screws were less commonly removed than all other fixation types (P = 0.01). TBWs (28/63) were more commonly removed than all other implants (6/29) (P < 0.05). The nonunion rate for olecranon osteotomies was 3.3%. TBWs (18/18) are more likely to be removed for implant irritation than plates. TBWs had an odds ratio of 3.29 for requiring implant removal if they were left >1 mm off of the olecranon tip. CONCLUSION In this study, 34 of the 92 (37%) patients undergoing an olecranon osteotomy for treatment of a distal humerus fracture required removal of olecranon implant. Screw fixation (0/10) was found to be removed less frequently than TBW fixation 28 of the 63 patients (44.4%). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander Meldrum
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Cory Kwong
- Southern California Orthopaedic Institute, University of Los Angeles, Los Angeles, CA
| | | | - David Cinats
- Department of Orthopedics, SUNY Upstate Medical University, Syracuse, NY; and
| | - Prism Schneider
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
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Augmented intramedullary screw tension band construct for olecranon fracture reduction and fixation: a review of literature and surgical technique. JSES Int 2020; 4:470-477. [PMID: 32939470 PMCID: PMC7479051 DOI: 10.1016/j.jseint.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Olecranon fractures, which make up 10% of upper extremity fractures in adults, often require anatomic reduction and stable internal fixation. Successful olecranon fracture osteosynthesis has classically been achieved via tension band wiring or plate fixation. This article reviews the indications, outcomes, and a surgical technique as an alternative construct for tension band wiring of olecranon fractures. The technique involves placement of an ulnar intramedullary partially threaded screw that is used as a proximal point of attachment for tension band wiring of the olecranon. Although infrequently used by orthopedic surgeons, this construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques. This review is intended to familiarize surgeons with a surgical technique that can be applied to a variety of proximal ulna fractures.
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Hahn A, O'Hara NN, Koh K, Zhang LQ, O'Toole RV, Andrew Eglseder W. Is intramedullary screw fixation biomechanically superior to locking plate fixation and/or tension band wiring in transverse olecranon fractures? A cadaveric biomechanical comparison study. Injury 2020; 51:850-855. [PMID: 32173084 DOI: 10.1016/j.injury.2020.02.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare clinically important mechanical properties of three techniques used to fix transverse olecranon fractures (Arbeitsgemeinschaft fur Osteosynthesefragen and Orthopaedic Trauma Association class 2U1B1): (1) intramedullary (IM) screw, (2) locking plate, and (3) tension band wire in a realistic loading protocol using a cadaveric model. METHODS Fresh frozen cadaveric transverse olecranon fracture models were fixed with an IM screw (n = 6), a locking plate (n = 6), or a tension band (n = 6). Compression after fixation was recorded using a pressure sensor in the fracture before samples were loaded through the triceps tendon for 500 cycles of 0-500 N, assessing implant survival. The primary outcome measure was compression force before loading. The secondary outcome was frequency of implant failure defined as breakage of the implant itself or fracture gapping >5 mm. Binary outcomes were compared with χ2, and continuous variables were compared with unadjusted analysis of variance and a multivariable regression model adjusting for age, sex, dual-energy X-ray absorptiometry T-score, and testing order. RESULTS No statistically significant difference was shown in fracture compression between IM screw (mean, 162 N; 95% confidence interval [CI], 27-297 N), locking plate (mean, 125 N; 95% CI, -9-260 N), and tension band (mean, 163 N; 95% CI, 29-298 N) in unadjusted (p = 0.89) and adjusted (p = 0.82) analyses. A 100% implant failure rate was observed with tension band compared with 0% implant failure with IM screw or locking plate (p < 0.01). CONCLUSION We found no statistically significant differences in compression across the fracture site among techniques. We did find a higher risk of implant failure with tension band compared with IM screw and locking plate during cyclic loading in cadaveric bone.
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Affiliation(s)
- Alexander Hahn
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kyung Koh
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Li-Qun Zhang
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - W Andrew Eglseder
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Understanding the Radiographic Anatomy of the Proximal Ulna and Avoiding Inadvertent Intraarticular Screw Placement. J Orthop Trauma 2020; 34:102-107. [PMID: 31809415 DOI: 10.1097/bot.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To map the proximal ulnar articular margins and ensure safe extraarticular placement of implants. METHODS Ten fresh frozen adult elbow cadaver specimens were obtained. Radiopaque wire was applied to the articular margin of the articular facets and the central trochlear ridge of the proximal ulna. Fluoroscopic images were obtained demonstrating the articular facet margins. Radiographic measurements were performed and used to identify relative safe screw zones. RESULTS All specimens demonstrated marked extension of the ulnar and radial facets dorsal to the central trochlear ridge. The dorsal extent of the ulnar facets from the central trochlear ridge averaged 9.7 mm (range, 7.9-13 mm; SD, 1.5 mm) and 6.2 mm (range, 3.4-9.4 mm; SD, 1.9 mm), respectively. The average footprint of the posterior ulnar facet occupied 44% (±4.9%) of the total ulnar height from the dorsal cortex to the trochlear ridge. CONCLUSIONS The articular margins of the anterior and posterior facets of the proximal ulna are challenging to identify radiographically. A surgical "at-risk zone" exists within 9.7 mm from the radiographic margin of the central trochlear ridge. Implants placed within this zone have the potential to violate the articular surface.
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Di Francia R, Letissier H, Le Nen D, Lefèvre C, Dubrana F, Stindel É. Advantages of expulsion-proof pins in the treatment of olecranon fractures with tension band wiring: Comparison with a control group. Orthop Traumatol Surg Res 2019; 105:1593-1599. [PMID: 31767442 DOI: 10.1016/j.otsr.2019.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/18/2019] [Accepted: 08/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tension band wiring is considered the standard treatment for transverse olecranon fractures. Its main complications are pin migration and discomfort caused by the hardware. We have designed and used "expulsion-proof" pins (EPP) that are shaped to prevent migration and reduce discomfort. This study compared the complication rate between our device and Kirschner pins (controls). HYPOTHESIS We hypothesised that EPP would have lower migration rates and fewer complications than standard Kirschner pins. MATERIALS AND METHODS This retrospective, single-center, multi-operator, observational, study examined data from January 1996 to December 2014. The primary outcome was the occurrence of pin migration. Secondary outcomes were the occurrence of one or more additional complications and the hardware removal rate. RESULTS The study enrolled 101 patients: 53 (52.4%) with expulsion-proof pins and 48 (47.6%) controls. The mean follow-up was 240.6days in the EPP group and 268.9days in the control group. No cases of migration (0%) were found in the EPP group versus 21 (43.7%) cases in the controls (p<0.05). One or more complications occurred in 18 (33.9%) patients in the EPP group versus 46 (95.8%) controls (p<0.05). There was material discomfort in 13 (24.5%) cases and 1 (1.9%) case of secondary displacement in the EPP group, compared with 38 (79.2%) and 7 (14.6%) cases, respectively, in the controls (p<0.05). The rate of delayed consolidation was statistically identical in the two groups (p=0.103). The hardware was removed in 13 (24.5%) cases in the EPP group compared with 36 (75%) controls (p<0.05). CONCLUSION EPPs are useful for management of olecranon fractures treated via TBW: the pins do not migrate and can reduce complications, discomfort, secondary displacement, and the hardware removal rate. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Rémi Di Francia
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France.
| | - Hoel Letissier
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France
| | - Dominique Le Nen
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France
| | - Christian Lefèvre
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France
| | - Frédéric Dubrana
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France
| | - Éric Stindel
- Centre Hospitalier Régional Universitaire de Brest, Service de Chirurgie Orthopédique et Traumatologique, 29200 Brest, France
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von Keudell A, Kachooei A, Mohamadi A, Mortensen SJ, Okajima S, Egan J, Weaver M, Dyer GSM, Nazarian A. Biomechanical properties of an intramedullary suture anchor fixation compared to tension band wiring in osteoporotic olecranon fractures- A cadaveric study. J Orthop 2019; 17:144-149. [PMID: 31879494 DOI: 10.1016/j.jor.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of the study is to compare three different fixation techniques for transverse olecranon repair in cadaveric osteoporotic bone: (1) current recommended AO tension band technique with K-wire fixation; (2) Suture anchor fixation and (3) Polyester suture fixation. Methods Evaluated with bone densitometry, 7 osteoporotic human elbow specimens were included in the study. A transverse olecranon fracture was reduced anatomically and were fixated first using a K-wire tension band technique, second using two suture anchors, and third using polyester suture. Static simulations of the kinetics associated with active range of motion (AROM) and push up from a chair exercises were performed with cyclic loading using Instron hydraulic testing apparatus. Fracture displacement was measured using videographic analysis. Failure was defined as 2 mm fracture displacement. Results The biomechanical analysis found no statistical difference in displacements between the three fixation methods when testing AROM. In simulated push-up exercises, polyester suture fixation failed after 17 cycles and had significantly higher displacement compared to the other two methods. No difference between the K-Wire fixation versus Suture anchor fixation was observed, p = 0.162. Conclusion Suture anchor fixation might be a viable surgical treatment option for osteoporotic transverse elbow fractures in geriatric patients.
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Affiliation(s)
- Arvind von Keudell
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Amir Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sharri J Mortensen
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Okajima
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jonathan Egan
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - MichaelJ Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA, USA
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Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reoperations and economics. Musculoskelet Surg 2018; 103:155-160. [PMID: 30006804 DOI: 10.1007/s12306-018-0556-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Simple displaced transverse olecranon fractures are traditionally managed operatively with a tension band wire device (TBW). We compared clinical outcomes, morbidity and the cost of treatment of TBW versus pre-countered low-profile locking plates for the treatment of Mayo 2A fractures. PATIENT AND METHODS All olecranon fractures admitted to our unit between 2008 and 2014 were identified (n = 129). Patient notes and radiographs were studied from presentation to final follow-up. Patient outcomes were recorded using the QuickDASH (Disabilities of Arm, Shoulder and Hand) score. Patient demographics and nature of complications were recorded as were the rate and nature of any repeat operation. RESULTS Eighty-nine patients had Mayo 2A fractures (69%). Sixty-four underwent TBW (n = 48) or locking plate fixation (n = 16). The mean ages of both groups were similar at 57 (15-93) and 60 (22-80), respectively. In the TBW group, the mean post-injury QuickDASH was 12.9, compared with 15.0 for the locking plate group. There was no statistically significant difference between the outcomes for either group. Nineteen of the 48 TBW patients had complications (39.6%). Sixteen of the 48 TBW patients had reoperations (33.3%). In particular, we would highlight that 13 (27.1%) of patients treated with TBW underwent subsequent removal of metalwork for hardware irritation. There were no complications and or reoperations in the 16 patients who received locking plate fixation. Both complication and reoperation rates were statistically significantly different. Despite being initially more expensive, when the cost of reoperation for TBW group was included, locking plates were found to be on average £236.33 less per patient than for TBW. CONCLUSIONS We suggest that locking plates are superior to TBW concerning post-operative morbidity, reoperation rate and cost for Mayo 2A fractures in contrast to previous articles. LEVEL OF EVIDENCE Therapeutic study, III.
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Gruszka D, Arand C, Greenfield J, Nowak TE, Kuechle R, Kuhn S, Rommens PM. Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones. Arch Orthop Trauma Surg 2017; 137:1651-1658. [PMID: 28864862 DOI: 10.1007/s00402-017-2760-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Tension band wiring (TBW) used for olecranon fractures is afflicted with a high rate of complications. The aim of this study was to compare the stability of the TBW versus an alternative, novel low-profile olecranon tension plate (OTP) with angular stable screws in a simulated complex fracture model. MATERIALS AND METHODS Nine fresh-frozen pairs of cadaver proximal ulnae with an oblique osteotomy and an additional wedge fragment simulating an unstable fracture were tested. The TBW and OTP were implanted pairwise. The elbow motion was simulated in a single-muscle model and ranged from full extension to 90° of flexion. The pulling force of the triceps tendon ranged from 50 to 200 N. The displacement of the fracture fragments was measured with a video motion analysis system over 304 cycles. Data were assessed statistically using the Wilcoxon signed-rank test. RESULTS The cyclic loading tests showed mean loosening of the fracture fragments at the articular surface of 0.56 mm using TBW (SD 0.65) and 0.15 mm for OTP (SD 0.39). There was no statistical significance in loosening between the two constructs (p = 0.31). No plate breakage or screw loosening occurred. CONCLUSIONS The low-profile OTP, using the principles of pre-tensioning, lag, cortical, and angular stable screws together, demonstrated similar stability after olecranon fracture fixation when compared with the TBW technique and a lag screw in the olecranon fracture model with a third wedge fragment.
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Affiliation(s)
- Dominik Gruszka
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
| | - Charlotte Arand
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Julia Greenfield
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.,GRESPI EA 4694, Faculty of Sport Sciences, University of Reims Champagne-Ardenne, Reims, France
| | - Tobias E Nowak
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Raphael Kuechle
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Kuhn
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Pol M Rommens
- Department of Orthopaedics and Traumatology, University Medical Center of Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
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Willinger L, Lucke M, Crönlein M, Sandmann GH, Biberthaler P, Siebenlist S. Malpositioned olecranon fracture tension-band wiring results in proximal radioulnar synostosis. Eur J Med Res 2015; 20:87. [PMID: 26514829 PMCID: PMC4625882 DOI: 10.1186/s40001-015-0184-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022] Open
Abstract
Background Tension-band wiring (TBW) is a well-established fixation technique for two-part, transverse fracture types of the olecranon. However, complication rates up to 80 % are reported. By reporting on the enormous impact on the patient if failed the aim of the present report was to emphasize the importance of correct K wire positioning in TBW. Case presentation We present the case of a 49-year-old woman who suffered from a radioulnar synostosis of the forearm due to malpositioned K wires after TBW treatment. The patient was treated by heterotopic bone resection supported by ossification prophylaxis (radiotherapy and Indomethacin). At follow-up of 12 months after revision surgery, elbow motion was unrestricted with a strength grade 5/5. The patient was free of pain and reported no restrictions in daily as well as sporting activities. Radiologic assessment showed no recurrence of heterotopic bone tissue. Conclusion Intraoperative radiographic and clinical examination of the elbow is highly recommended to identify incorrect hardware positioning and, therefore, to avoid serious postoperative complications in TBW.
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Affiliation(s)
- Lukas Willinger
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Martin Lucke
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Gunther H Sandmann
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
| | - Sebastian Siebenlist
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
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Uhlmann M, Barg A, Valderrabano V, Weber O, Wirtz DC, Pagenstert G. [Treatment of isolated fractures of the olecranon: percutaneous double-screw fixation versus conventional tension band wiring]. Unfallchirurg 2015; 117:614-23. [PMID: 23754551 DOI: 10.1007/s00113-013-2389-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Isolated fractures of the olecranon account for 7-10% of all osseous injuries in adults. These fractures are usually treated surgically by conventional tension band wiring. The percutaneous double-screw fixation is an optional treatment in patients with two fragment olecranon fractures with some postoperative advantages. PATIENTS AND METHODS A total of 13 patients with isolated fractures of the olecranon (Schatzker-Schmelling type A) treated by percutaneous double-screw fixation were included in this prospective study. The mean age of patients was 43.6 ± 11.0 years. Intraoperative and postoperative complications were recorded. Functional results were assessed after a mean follow-up of 38.2 ± 11.5 months using the Quick-DASH score. The results were compared with those obtained in the control group including 26 patients treated by conventional tension band wiring. RESULTS No intraoperative complications were observed in both groups. In the group with percutaneous double-screw fixation the scar length was significantly shorter (2.4 ± 0.4 cm vs. 11.0 ± 1.8 cm, p < 0.001) and the hardware removal was substantially less frequent that in the group with conventional tension band wiring with 38.5 % and 73.1 %, respectively. At the minimum follow-up of 2 years comparable functional results were obtained in both groups (Quick-DASH score 2.3 vs. 0.0 points, respectively, p = 0.155); however, the range of elbow motion was significantly higher in the group with percutaneous double-screw fixation (extension/flexion 145° vs. 130°, p < 0.001; pronation/supination 165° vs. 155°, p < 0.001). CONCLUSIONS The percutaneous double-screw fixation is a safe and viable treatment option in patients with isolated fractures of the olecranon (Schatzker-Schmelling type A). The functional results regarding DASH scores obtained using this technique were comparable with those observed in patients with conventional tension band wiring; however, range of elbow motion and cosmetic results were significantly better in the patient group with percutaneous double-screw fixation.
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Affiliation(s)
- M Uhlmann
- Klinik für Orthopädie, Universitätsklinikum Basel, Spitalstraße 21, CH-4031, Basel, Schweiz
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Gruszka D, Arand C, Nowak T, Dietz SO, Wagner D, Rommens P. Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study. INTERNATIONAL ORTHOPAEDICS 2015; 39:955-60. [PMID: 25711396 DOI: 10.1007/s00264-015-2703-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/02/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE The complication rate of a tension band wiring (TBW) used for the internal fixation of olecranon fractures remains high. The aim of this study was to compare the stability of a novel olecranon tension plate (OTP) with TBW in a simulated fracture model. METHODS We tested 12 fresh frozen-pairs of cadaver proximal ulnae treated with OTP and TBW under cyclic loading. The elbow motion ranged from full extension to 90° of flexion, and the pulling force of the triceps tendon ranged from 50 to 350 N. The displacement of the fracture fragments was measured continuously. Data were assessed statistically using the Wilcoxon test with significance level of p < 0.05. RESULTS The cyclic loading tests showed median displacements of the fracture fragments of 0.25 mm using OTP and 1.12 mm for TBW. Statistical analysis showed the difference to be substantial (p = 0.086) but not statistically significant. No plate breakage or screw loosening occurred. CONCLUSIONS The concept of replacing prominent K-wires at the proximal end of the ulna using an low-profile plate with classical lag and multidirectional angle-stable screws demonstrated biomechanical advantages over TBW.
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Affiliation(s)
- Dominik Gruszka
- Department of Orthopaedics and Traumatology, University Medical Center, Mainz, Germany,
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Niéto H, Billaud A, Rochet S, Lavoinne N, Loubignac F, Pietu G, Baroan C, Espie A, Bonnevialle P, Fabre T. Proximal ulnar fractures in adults: a review of 163 cases. Injury 2015; 46 Suppl 1:S18-23. [PMID: 26528935 DOI: 10.1016/s0020-1383(15)70006-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of this study was to report the epidemiological characteristics and the experience of 5 departments of trauma, in France, in the management of fractures of the proximal ulna. 163 patients with fractures of the proximal ulna with a mean age of 49.9 years (range 16-97) were managed. The most common mode of injury was a motor vehicle collision (48%). 18% sustained associated injuries to the ipsilateral limb. Open fractures were present in 42 patients (25%). A total of 109 patients had a fracture of the olecranon, with the Mayo 2A and B types most frequently seen (66%). The patients were invited for clinical examination at a mean duration of 16 months, retrospectively. Validated patient-oriented assessment scores involving the Mayo Elbow Performance Index (MEPI) and the Broberg and Morrey score were evaluated. All patients had follow-up radiographs. The mean arc of elbow motion was 130° (70-150°). The mean MEPI was 91 (20-100) with good results in 23% and excellent results in 52% of the patients. The mean Broberg and Morrey score was 90 after isolated olecranon fracture, and decreased with the complexity of the lesion. 117 fractures (72%) healed with ulnohumeral congruity. 9 fracture non-unions occurred (6%). Although the fracture of the proximal ulna can be described in several classifications, none of them accommodate it satisfactorily, because of the complexity of the lesion. The coronoid process is the keystone for the stability of the elbow. It forms the anterior buttress with the radial head. Tension band wire fixation is by far the commonest technique of internal fixation used for the treatment of non-comminuted olecranon fractures. Dorsal plate fixation is a useful option by providing improved fixation of complex comminuted fractures and fracture-dislocations. The radiocapitellar joint has to be restored appropriately, preserving the radial head when possible and replacing it with a prosthesis otherwise. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. In addition, a brief period of hinged external fixation should be considered.
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Affiliation(s)
- H Niéto
- Department of Trauma and Orthopaedics, Niort, France
| | - A Billaud
- Department of Trauma and Orthopaedics, Pau, France
| | - S Rochet
- University Hospital of Besançon, France
| | - N Lavoinne
- Department of Trauma and Orthopaedics, Saint Jean de Luz, France
| | - F Loubignac
- Department of Trauma and Orthopaedics, Toulon, France
| | - G Pietu
- University Hospital of Nantes, France
| | - C Baroan
- Department of Trauma and Orthopaedics, Niort, France
| | - A Espie
- Department of Trauma and Orthopaedics, Albi, France
| | | | - T Fabre
- University Hospital of Bordeaux, France
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Kim W, Choi S, Yoon JO, Park HY, Kim SH, Kim JS. Double tension band wiring for treatment of olecranon fractures. J Hand Surg Am 2014; 39:2438-43. [PMID: 25447004 DOI: 10.1016/j.jhsa.2014.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/10/2014] [Accepted: 09/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE Although tension band wiring (TBW) is generally accepted as standard treatment for olecranon fractures, it has several shortcomings such as loss of reduction, skin irritation, and migration of the K-wires. To overcome these problems and increase fixation stability, we used a rigid fixation technique with double tension band wiring (DTBW). Here, we describe the technique and outcomes of the treatment. METHODS We retrospectively reviewed 21patients with olecranon fractures who were treated by DTBW. We evaluated clinical and radiological outcomes by checking the range of motion, loss of reduction, functional scoring, skin complications, and pin migration. There were 15 cases of Mayo type IIA fractures (71%) and 6 of type IIB fractures (29%). The mean follow-up period was 37 months (range, 12-58 mo). We also compared the mechanical stability of DTBW and TBW in a sawbone model using a single cycle load to failure protocol. RESULTS All fractures united without displacement, and no migration of the K-wires was observed during the period of follow-up. Mean loss of elbow extension was 2° (range, 0°-15°) and mean elbow flexion was 134° (range, 125°-140°). The mean Mayo Elbow Performance Score was 94 (range, 70-100). Biomechanical testing revealed greater mechanical strength in the DTBW technique than in the TBW when measured by mean maximum failure load and mean bending moment at failure. CONCLUSIONS DTBW produced good clinical and radiological outcomes and could be an effective option for the treatment of olecranon fractures by providing additional stability through a second TBW. Biomechanical comparison with a control group (TBW) supported the mechanical benefits of DTBW. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Wanlim Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea
| | - Sunghun Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea
| | - Jun O Yoon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea
| | - Ho Youn Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea
| | - Sun Hwa Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea
| | - Jin Sam Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University, Gyeonggi-do, South Korea.
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Tarallo L, Mugnai R, Adani R, Capra F, Zambianchi F, Catani F. Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg 2014; 134:1107-14. [PMID: 24935660 DOI: 10.1007/s00402-014-2021-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The purpose of this retrospective study is to compare the clinical, functional outcome and complications occurrence between tension band wiring (TBW) and plate fixation both for simple and comminuted displaced olecranon fractures. MATERIALS AND METHODS Between January 2005 and June 2012 (minimum 1-year follow-up), 78 consecutive patients with Mayo type IIA and IIB fractures were treated with the following methods: tension band wire or plate and screws fixation. The primary outcome of this study was the functional outcome, assessed by the following self-administered evaluation scales: the disabilities of the arm, shoulder and hand, and the Mayo Elbow Performance Score. Secondary outcome measures included the assessment of pain level, analysis of passive range of motion, and the occurrence of any early or late complications. RESULTS Comparing the clinical results between the two groups, at mean 33 months follow-up, no significant differences in the functional and clinical outcome were observed. Complications were reported in 48 and 17 % of cases, following TBW and plate fixation in patients treated for type IIA fractures, and similarly in 40 and 23 % of cases in type IIB fractures, respectively. Hardware removal was more frequently performed in TBW group: 38 versus 17 % for type IIA fractures and 20 versus 6 % for type IIB fractures. CONCLUSIONS The findings of this study indicate that both with the use of TBW and plate fixation excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability can be obtained in the majority of patients with simple and comminuted displaced olecranon fractures. Hardware removal was most frequently observed after TBW.
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Affiliation(s)
- Luigi Tarallo
- Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy,
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Karthik K, Tahmassebi R, Tavakkolizadeh A, Compson J. Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture. Strategies Trauma Limb Reconstr 2014; 9:121-5. [PMID: 25063222 PMCID: PMC4122682 DOI: 10.1007/s11751-014-0197-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 07/21/2014] [Indexed: 11/25/2022] Open
Abstract
A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30° on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6 months, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis.
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Affiliation(s)
- Karuppaiah Karthik
- Upper Limb Unit, Department of Orthopaedic Surgery, King's College Hospital, Denmark Hill, London, SE59RS, UK,
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Beşer CG, Demiryürek D, Özsoy H, Erçakmak B, Hayran M, Kızılay O, Özsoy A. Redefining the proximal ulna anatomy. Surg Radiol Anat 2014; 36:1023-31. [DOI: 10.1007/s00276-014-1340-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/28/2014] [Indexed: 11/27/2022]
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Schneider MM, Nowak TE, Bastian L, Katthagen JC, Isenberg J, Rommens PM, Müller LP, Burkhart KJ. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. INTERNATIONAL ORTHOPAEDICS 2014; 38:847-55. [PMID: 24326359 PMCID: PMC3971280 DOI: 10.1007/s00264-013-2208-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 11/14/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique. METHODS This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning. RESULTS On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91% of all cases), the use of a single wire knot (78%) and nonparallel K-wires (72%). Mayo IIa (n = 188) was the most common fracture type. CONCLUSIONS Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated. LEVEL OF EVIDENCE IV, treatment study.
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Affiliation(s)
- Marco M Schneider
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Albertus Magnus University, Cologne, Germany,
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Kim JY, Lee YH, Gong HS, Lee SL, Lee SK, Baek GH. Use of Kirschner wires with eyelets for tension band wiring of olecranon fractures. J Hand Surg Am 2013; 38:1762-7. [PMID: 23849734 DOI: 10.1016/j.jhsa.2013.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 05/10/2013] [Accepted: 05/10/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of tension band wiring of displaced olecranon fractures treated using Kirschner wires with eyelets to assess their clinical performance with respect to complications such as backing out of the K-wires, restriction of forearm rotation, and neurovascular injury. METHODS The authors retrospectively reviewed 44 patients treated for an isolated, displaced olecranon fracture and checked range of motion, postoperative pain, complications, and incidence of hardware removal. The mean follow-up period was 41 months (range, 26-73 mo). RESULTS All fractures united, and anatomical reduction was achieved in all cases at final follow-up. Mean elbow flexion was 135° (range, 115° to 140°), and mean elbow extension was 4° (range, 0° to 15°). No pin migration, restriction of forearm rotation, or neurovascular injury occurred. Hardware removal was performed in 8 cases (18%). Compared to previous results with conventional Kirschner wires, no meaningful improvement in postoperative pain level or in the rate of hardware removal was observed. CONCLUSIONS Tension band wiring using the pin studied produced excellent clinical and radiologic outcomes for the treatment of isolated, displaced Mayo type IIA and some type IIB olecranon fractures. The pin was effective in preventing the backing out of Kirschner wires and avoiding the complications associated with anterior cortical engagement of Kirschner wires, such as neurovascular injury or restriction of forearm rotation.
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Affiliation(s)
- Jin Young Kim
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Chen X, Liu P, Zhu X, Cao L, Zhang C, Su J. Design and application of nickel-titanium olecranon memory connector in treatment of olecranon fractures: a prospective randomized controlled trial. INTERNATIONAL ORTHOPAEDICS 2013; 37:1099-105. [PMID: 23595232 DOI: 10.1007/s00264-013-1878-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 03/13/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE We carried out this study to test the efficacy of the olecranon memory connector (OMC) in olecranon fractures. METHODS We designed a prospective randomised controlled trial involving 40 cases of olecranon fractures. From May 2004 to December 2009, 40 patients with olecranon fractures were randomly assigned into two groups. Twenty patients were treated with OMC, while another 20 patients were fixed with locking plates in our hospital. The DASH score, MEP score, range of motion and radiographs were used to evaluate the postoperative elbow function and complications. RESULTS For MEP score, OMC was better than the locking plate; for DASH score, complication rate, and range of elbow motion, the two methods presented no significant difference. CONCLUSION The study showed that OMC could be an effective alternative to treat olecranon fractures.
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Affiliation(s)
- Xiao Chen
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, NO.168 Changhai Road, Shanghai, 200433, People's Republic of China
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Traa WA, Oomen PJA, den Hamer A, Heusinkveld MHG, Maffulli N. Biomechanical studies on transverse olecranon and patellar fractures: a systematic review with the development of a new scoring method. Br Med Bull 2013; 108:131-57. [PMID: 23902795 DOI: 10.1093/bmb/ldt020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Several methods of transverse patellar and olecranon fixation have been described. This article compares biomechanical studies of various fixation methods using a newly developed scoring method. SOURCE OF DATA The databases PubMed, Web of Science, Science Direct, Google Scholar and Google were searched for relevant studies. AREAS OF AGREEMENT Fixation hardware failure remains a problem. Various materials and fixation techniques have been tested to provide an improved fixation of transverse olecranon and patellar fractures. AREAS OF CONTROVERSY The difference in biomechanical testing setup between the studies makes it hard to compare different fixation techniques. GROWING POINTS The newly developed grading method was proved to be unbiased and reliable; however, extra specifications need to be added at some criteria when adopting the scoring method. AREAS TIMELY FOR DEVELOPING RESEARCH Non-metallic constructs may provide an improvement to the currently used metallic tension band wiring technique; however, clinical research is required.
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Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Liu QH, Fu ZG, Zhou JL, Lu T, Liu T, Shan L, Liu Y, Bai L. Randomized Prospective Study of Olecranon Fracture Fixation: Cable Pin System versus Tension Band Wiring. J Int Med Res 2012; 40:1055-66. [PMID: 22906278 DOI: 10.1177/147323001204000324] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE: This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. METHODS: Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. RESULTS: The mean ± SD fracture healing time was significantly shorter in the CPS group ( n = 30; 9.73 ± 2.02 weeks) compared with the TBW group ( n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. CONCLUSIONS: Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.
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Affiliation(s)
- Q-H Liu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Z-G Fu
- Department of Orthopaedics, People's Hospital, Peking University, Beijing, China
| | - J-L Zhou
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - T Lu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - T Liu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - L Shan
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Y Liu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - L Bai
- Department of Orthopaedics, People's Hospital, Peking University, Beijing, China
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van der Linden SC, van Kampen A, Jaarsma RL. K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 2012; 21:405-11. [PMID: 22036542 DOI: 10.1016/j.jse.2011.07.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/22/2011] [Accepted: 07/24/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tension-band wiring (TBW) has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to examine the effect of K-wire position on instability of the K-wires in relation to local complications and radiological and clinical long-term outcome. METHODS We reviewed the early follow-up of 59 patients (mean age, 60 years) who underwent TBW osteosynthesis for displaced olecranon fractures. Follow-up information was available from medical records and radiographs. The main outcome measurements were proximal migration of the wires, gap, step, range of motion, and complications. Long-term follow-up included 21 patients (mean age, 58 years). Follow-up was available from a clinical visit and a radiograph. Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm Shoulder and Hand (DASH), EuroQol-5D (EQ-5D), and Broberg and Morrey osteoarthritis scores were obtained. RESULTS Seventy-eight percent of the patients treated with intramedullary K-wires were found to have instability of K-wires, compared to 36% in the patients treated with transcortical K-wires. Patients with instability of the K-wires tend to develop osteoarthritis more often. There is a better functional outcome in patients where the osteosynthetic material is removed. CONCLUSION Instability of K-wires after TBW is more common after intramedullary placement of the wires resulting in proximal migration of the K-wires and gap appearance. There was a tendency of more osteoarthritis in the group of patients where instability of K-wires was identified. We would recommend the use of transcortical placed wires, as well as to have a low threshold in removing the implants.
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Affiliation(s)
- Sabine C van der Linden
- Department of Orthopaedics and Traumatology, Flinders University Medical Centre, Adelaide, Australia
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Duckworth AD, Court-Brown CM, McQueen MM. Isolated displaced olecranon fracture. J Hand Surg Am 2012; 37:341-5. [PMID: 21741776 DOI: 10.1016/j.jhsa.2011.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/05/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK.
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Catalano LW, Crivello K, Lafer MP, Chia B, Barron OA, Glickel SZ. Potential dangers of tension band wiring of olecranon fractures: an anatomic study. J Hand Surg Am 2011; 36:1659-62. [PMID: 21864995 DOI: 10.1016/j.jhsa.2011.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 07/01/2011] [Accepted: 07/07/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Displaced olecranon fractures are often amenable to treatment with open reduction and tension-band wiring. The purpose of this study is to examine the relationships of the tips of K-wires used in a tension-band construct to volar neurovascular structures in the proximal forearm and the proximal radioulnar joint. METHODS We performed simulated percutaneous pinnings of the proximal ulna under fluoroscopic guidance on 15 cadavers with intact proximal ulnas. The K-wires were drilled obliquely through the tip of the olecranon process and directed to engage the anterior ulnar cortex, distal to the coronoid. Using calipers, we measured the distance from the tip of each pin to the anterior interosseous nerve (AIN), ulnar artery, proximal radioulnar joint (PRUJ), and volar cortex of the ulna, as well as the distance from the volar cortex of the ulna to the AIN and ulnar artery. The angle created by the K-wires and the longitudinal axis of the ulna was measured on both anteroposterior and lateral radiographs. RESULTS The distance from pin tip to the AIN and ulnar artery measured a mean of 16 mm with a standard deviation of 6 mm and 14 mm with a standard deviation of 5 mm, respectively, with 1 pin abutting the artery. The shortest distance from both the AIN (11 ± 5 mm) and the ulnar artery (8 ± 6 mm) was measured with the shallowest angle of insertion, ranging from 10° to 14.9° on lateral radiographs. The mean distance between the pin tip and the PRUJ measured 7 mm with a standard deviation of 4 mm, with 3 pins penetrating the PRUJ. CONCLUSIONS The impaction of K-wires under the triceps is often approximately 1 cm, which is similar to the distance of the K-wire tips to the AIN and ulnar artery. Our findings suggest that larger insertion angles might help avoid neurovascular injury when the insertion point of the K-wires is at or just proximal to the tip of the olecranon. In this study, the safe zone for pin insertion on the anteroposterior view is 0° to 10°, and on the lateral view it is 20° to 30°. CLINICAL RELEVANCE This anatomic study was done to diminish the chance of complications resulting from K-wire placement during tension-band wiring for olecranon fractures.
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Affiliation(s)
- Louis W Catalano
- C.V. Starr Hand Surgery Center, St. Luke’s-Roosevelt Hospital, 1000 Tenth Ave., 3rd Floor, New York, NY 10019, USA.
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Molony DC, Kennedy J, Gheiti A, Mullett JH. Free-hand versus novel specialised jig guidance for the passing of intramedullary wires in olecranon fracture fixation: a comparative study. Injury 2011; 42:343-6. [PMID: 20356591 DOI: 10.1016/j.injury.2010.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/20/2010] [Accepted: 02/26/2010] [Indexed: 02/02/2023]
Abstract
The treatment of olecranon fractures frequently involves the use of tension-band fixation. Although associated with high union rates, this method has a high incidence of morbidity associated with soft tissue compromise and limitation of range of movement requiring frequent re-operation for removal of metal. We describe the use of a simple jig to ensure intramedullary placement of longitudinal K-wires and compare the accuracy of placement of Kirschner (K)-wires using this device with the traditional free-hand method. We found the distance from the centre of the medullary canal, the range and standard deviations of K-wire positions to be significantly more precise when the jig was used. This has applications for the use of the device, both with standard metallic radio-opaque wires and potentially with bio-absorbable pins.
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Affiliation(s)
- Diarmuid C Molony
- Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin 11, Ireland.
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Kuo CC, Hsu HC, Hong SW, Lu TW. BIOMECHANICAL ASSESSMENT OF TENSION-BAND WIRING FOR OLECRANON FRACTURES. BIOMEDICAL ENGINEERING: APPLICATIONS, BASIS AND COMMUNICATIONS 2011. [DOI: 10.4015/s1016237211002402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Tension-band wiring is the preferred method of treatment for olecranon fractures and is widely used throughout the world. This technique simply and effectively transforms the forces produced by the pulling of the triceps into forces causing compression of the fracture. Although the procedure is associated with a high union rate, the incidence of skin complications is also high. The most frequent complication is symptomatic prominence of the Kirschner wires (K-wires). The purpose of this retrospective study was to identify the optimal fixation of tension-band wiring in the treatment of olecranon fractures using biomechanical techniques. Sixty-two patients were divided into two groups: a bicortical Kirschner wire group and an intramedullary K-wire group. The migration rate of the K-wires and the union rate of fractured bone were measured in both groups. Achievement of radiographic union was similar in the two groups. However, the K-wire migration rate was higher in the intramedullary K-wire group than in the bicortical K-wire group. With appropriate surgical technique, the use of bicortical K-wires is biomechanically superior to the use of intramedullary K-wires in the treatment of olecranon fractures.
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Affiliation(s)
- Chien-Chung Kuo
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| | - Horng-Chaung Hsu
- Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wun Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
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Sadri H, Stern R, Singh M, Linke B, Hoffmeyer P, Schwieger K. Transverse fractures of the olecranon: a biomechanical comparison of three fixation techniques. Arch Orthop Trauma Surg 2011; 131:131-8. [PMID: 20680308 DOI: 10.1007/s00402-010-1156-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The gold standard for treating transverse olecranon fractures is tension band fixation. A problem with this technique is migration of the K-wires leading to premature hardware removal. The aim of this study is to compare stability provided by two new techniques designed to eliminate the problem with backing out of K-wires, with that of the recommended tension band technique, performed with a biomechanical in vitro investigation. Our hypothesis was that the two new techniques would provide at least equal stability as the traditional tension band fixation. METHODS Transverse olecranon osteotomies were created in human cadaveric elbows to simulate a type 21-B1.1 fracture. Three groups of 8 specimens were instrumented with: (1) recommended AO tension band technique; (2) modified K-wires with eyelets and tension band; (3) staples across the fracture with tension band. Each elbow was tested in a 90° flexed position. The triceps tendon was sinusoidally loaded by applying two load steps at 500 and 700 N for 4000 cycles each. Relative movements between the fragments were determined. RESULTS At the end of the first and second load step the displacement of the osteotomy at the posterior ulnar side was significantly less for the staples across the fracture with tension band as compared to both other groups. There were no significant differences between groups 1 and 2. CONCLUSION Since clinical results depend partly on stable fixation, it is concluded that using staples in the clinical situation might provide better results than the currently recommended tension band technique.
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Affiliation(s)
- Hassan Sadri
- University Hospital Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
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Lee SH, Han SB, Jeong WK, Park JH, Park SY, Patil S. Ulnar artery pseudoaneurysm after tension band wiring of an olecranon fracture resulting in Volkmann's ischemic contracture: a case report. J Shoulder Elbow Surg 2010; 19:e6-8. [PMID: 19740681 DOI: 10.1016/j.jse.2009.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 06/11/2009] [Accepted: 06/15/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Soon-Hyuck Lee
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
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Tension Band Wiring for Olecranon Fractures: Relative Stability of Kirschner Wires in Various Configurations. ACTA ACUST UNITED AC 2010; 68:173-6. [DOI: 10.1097/ta.0b013e3181ad554c] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koslowsky TC, Mader K, Dargel J, Schadt R, Koebke J, Pennig D. Olecranon fracture fixation with a new implant: biomechanical and clinical considerations. Injury 2009; 40:618-24. [PMID: 19394014 DOI: 10.1016/j.injury.2009.01.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 01/19/2009] [Accepted: 01/20/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED This study aims to describe the first clinical results in the treatment of dislocated olecranon fractures with 2.2-mm, fine-threaded wires with a washer. Furthermore, in the second part of the article, the stability of these new implants has been compared to standard tension band wiring in a sawbone model. PATIENTS The radiological and clinical outcomes in 24 patients (mean age: 53.6 years) with 24 isolated Mayo type I and II fractures of the olecranon were evaluated in a prospective study after open reduction and internal fixation (ORIF) with a new fixation device (FFS; Orthofix). The quality of reduction with the implementation of 24 FFS constructions was compared with 24 tension band-wiring procedures performed by six different surgeons in a standard sawbone Mayo type IIa fracture model. Stability was tested in all constructs using a single cycle load to failure protocol (group I), cyclic loading for 300 cycles between 10 and 500 N (group II) and incremental sinusoidal loading from 10 to 200 N with an incremental increase of 10 N per cycle (group III) in a laboratory study. RESULTS The Morrey elbow score was excellent in 23 patients and good in one patient, with mean DASH score of 1.6. No implant migration, secondary dislocation or nonunion was observed. In the sawbone model, the quality of reduction was the same with the FFS implants compared to the tension band wiring in the sawbone model. Here, bending moments in all three groups showed no significant difference, whereas displacement at failure was significantly greater in the tension band-wiring group at a single cycle load (p=0.017). CONCLUSION Clinical results were comparable to tension band wiring and stability of the implants in the sawbone model was the same; thus, we conclude that the FFS technique can serve as an alternative treatment option for isolated olecranon fractures.
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Affiliation(s)
- Thomas C Koslowsky
- Department of Surgery, St. Elisabeth Hospital, Werthmannstrasse 1, D-50935 Cologne, Germany.
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Abstract
Several options exist for the management olecranon fractures. These include tension band, plate and intramedullary fixation techniques as well as fragment excision with triceps advancement and non-operative management. No one technique is suitable for the management of all olecranon fractures. In deciding how to treat this common trauma presentation, the surgeon needs a good understanding of the anatomy, different fracture morphologies, surgical options and potential complications. With appropriate management and early mobilisation good functional results can be expected in the majority of patients.
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De Carli P, Gallucci GL, Donndorff AG, Boretto JG, Alfie VA. Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: a case report. J Shoulder Elbow Surg 2009; 18:e40-4. [PMID: 19393921 DOI: 10.1016/j.jse.2009.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 02/04/2009] [Accepted: 02/07/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Pablo De Carli
- Department of Hand and Upper Extremity Surgery, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Prayson MJ, Iossi MF, Buchalter D, Vogt M, Towers J. Safe zone for anterior cortical perforation of the ulna during tension-band wire fixation: a magnetic resonance imaging analysis. J Shoulder Elbow Surg 2008; 17:121-5. [PMID: 18308204 DOI: 10.1016/j.jse.2007.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/08/2007] [Accepted: 04/08/2007] [Indexed: 02/01/2023]
Abstract
Placing K-wires obliquely through the anterior ulnar cortex is a common modification of traditional olecranon tension-band wiring. Wire tip protrusion, however, risks injury to adjacent neurovascular structures and may impede forearm rotation. This study examines the proximity of neurovascular structures to the anterior proximal ulnar cortex. The anatomy of 47 adult elbows was examined through magnetic resonance imaging. A radiologist measured the spatial relationship of 6 neurovascular structures to a mid-sagittal reference point 1.5 cm distal to the coronoid on the anterior surface of the ulna. Distance and angular measurements were made in the transverse plane of the reference point. Within a reasonable arc of K-wire placement, the ulnar artery and median nerve were at greatest risk yet were still beyond 10 mm from the anterior ulnar cortex. To avoid iatrogenic neurovascular injury during tension-band wiring of the olecranon, protrusion of wire tips beyond the anterior ulnar cortex should be no more than 1 cm at a distance of 1.5 cm distal to the coronoid.
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Abstract
OBJECTIVES We hypothesize that clinical results and patient outcomes following treatment of olecranon fractures with a congruent elbow plating system will be comparable to other available plating systems. Our results will be compared to previously published reports. DESIGN Retrospective study. SETTING Level 1 academic referral center. PATIENTS/PARTICIPANTS The trauma registry was reviewed to identify all olecranon fractures treated with open reduction and internal fixation between January 2001 and December 2004 using the Mayo Congruent Elbow Plate system. Thirty-two patients were identified. Postoperative range of motion was initiated within 2 weeks postoperatively. Mean time to follow-up was 2.2 years (0.7-5.1). All patients had follow-up radiographs. Outcome scores were available on 24 of the 32 patients. INTERVENTION Medical records and radiographs of all patients were reviewed. MAIN OUTCOME MEASUREMENTS Objective measures included radiographic healing, postoperative range of motion, and complications. Subjective functional results included Mayo Elbow Performance (MEP) score; Disability of the Arm, Shoulder, and Hand (DASH) score; and patient satisfaction. RESULTS Of the 32 fractures, 30 went on to union. Three patients had symptomatic hardware that was removed. There was 1 infection and 1 failure of fixation also requiring hardware removal. Average arc of motion was 120 degrees. Subjective follow-up was available in 75% of patients. Mean DASH was 32. Mean MEPS was 89, with 92% good or excellent results. CONCLUSIONS Congruent anatomic plating is a safe, effective option for the treatment of olecranon fractures with a low rate of hardware removal and stability with early motion.
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Affiliation(s)
- Meredith L Anderson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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Matthews F, Trentz O, Jacob AL, Kikinis R, Jupiter JB, Messmer P. Protrusion of hardware impairs forearm rotation after olecranon fixation. A report of two cases. J Bone Joint Surg Am 2007; 89:638-42. [PMID: 17332114 DOI: 10.2106/jbjs.e.01238] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Felix Matthews
- Division of Trauma Surgery, University Hospital of Zurich, Zurich, Switzerland
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