Osteosynthesis and Trauma Care 2005; 13(2): 67-75
DOI: 10.1055/s-2005-836330
Original Article

© Georg Thieme Verlag Stuttgart · New York

Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

J. Gehr1 , F. Hilsenbeck1 , W. Friedl1
  • 1Klinikum Aschaffenburg, Aschaffenburg, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
31. Mai 2005 (online)

Abstract

Introduction: The open reduction and internal fixation of olecranon fractures places high demands on the fixation device regarding the osseous anchorage and soft-tissue damage. In tension-band wiring, implant loosening and failure of osteosynthesis are frequent complications following mobilization. One of the biomechanical reasons given for this is the eccentric position of the tension band. Plate osteosynthesis - reserved for the more complex types of fracture - does not always provide sufficient stability, particularly in the case of fractures associated with osteoporosis and additional medial, lateral, frontal and extremely small proximal fragments. Another problem is the subcutaneous position of the implant, which can increase soft-tissue complications. Materials and Methods: The IP-X(X)S(L) nail described here is a locking nail with the option of interfragmentary compression. It is locked by threaded K-wires and has been used for all olecranon fractures treated in our clinic since May 1999. From May 1999 until December 2002, 80 olecranon fractures were treated with the XS nail. After an average period of 15 months, 73 of these 80 (follow-up 91.3 %) patients were investigated. Included in this group were 49 (67.1 %) patients with comminuted fractures and 24 (32.9 %) patients with two-fragment fractures. Olecranon osteotomies were excluded. Results: There were six (8.2 %) cases of dislocation of the transverse locking wires, two requiring re-osteosynthesis which were without complications. Two (2.7 %) cases had to be revised because of irritation of nerve structures. No cases of acute or chronic osteitis, implant failure or non-union after primary XS-nail osteosynthesis were found. Using the Murphy score, 47 (64.4 %) excellent, 21 (28.8 %) good, 3 (4.1 %) satisfactory and 2 (2.7 %) poor results were obtained in this group. Conclusion: The IP-XS nail fulfills the requirements of minimal soft-tissue trauma and secure fixation in the treatment of all types of olecranon fractures.

References

  • 1 Chaplin D M. Tension band wiring; a method to prevent “backing out” of the Kirschner wire.  Injury. 1975;  7 57
  • 2 Coleman N P, Warren P J. Tension band fixation of olecranon fractures. A cadaver study of elbow extension.  Acta Orthop Scand. 1990;  61 58-59
  • 3 Colton C L. Fractures of the olecranon in adults: Classifications and management.  Injury. 1973;  5 121
  • 4 Finsen V. et al . AO tension-band osteosynthesis of displaced olecranon fractures.  Orthop J. 2000;  23 1069-1071
  • 5 Friedl W. Zuggurtungsnagelsystem für axiale Kompressionsosteosynthese der Patella. 62. Jahrestag der Deut. Ges. für Unfallchirurgie e. V. 1998; p. 721
  • 6 Gehr J, Friedl W. Probleme der Zuggurtungsosteosynthese von Patellafrakturen und deren Konsequenzen für weitere Implantatentwicklungen. Der XS-Nagel.  Der Chirurg. 2001;  72 1309-1318
  • 7 Hak D J, Golladay G J. Olecranon fractures; Treatment options.  J Am Acad Orthop Surg. 2000;  8 266-273
  • 8 Horne J G, Tanzer T L. Olecranon fractures: A review of 100 cases.  J Trauma. 1981;  21 469
  • 9 Hume M C, Wiss A D. Olecranon fractures: A clinical and radiographic comparison of tension band wiring and plate fixation.  Clin Orthop Rel Res. 1992;  285 229-235
  • 10 Hutchinson D T, Daniel S. et al . Cyclic loading of olecranon fracture fixation constructs.  J Bone Joint Surg [Am]. 2003;  85 831-837
  • 11 Ikeda M, Fukushima Y, Kobayashi Y, Oka Y. Comminuted fractures of the olecranon.  J Bone Joint Surg [Br]. 2001;  83 806-808
  • 12 Jensen C M, Olsen B B. Drawbacks of traction-absorbing wiring (TAW) in displaced fractures of the olecranon.  Injury. 1986;  17 174-175
  • 13 Labitzke R. Zuggurtung am Beispiel der Patella.  Chirurg. 1997;  67 638
  • 14 Labitzke R. Laterale Zuggurtung - sofort belastungsstabile Osteosynthese der Patellafraktur.  Arch Orthop Unfallchir. 1977;  90 77
  • 15 Larsen E, Jensen C M. Tension-band wiring of olecranon fractures with non-sliding pins. Report of 20 cases.  Acta Orthop Scand. 1991;  62 360-362
  • 16 Mullett J H. et al . K-wire position in tension band wiring of the olecranon - A comparison of two techniques.  Injury. 2000;  31 427-431
  • 17 Murphy D R, Greene W B, Dameron T B. Displaced olecranon fractures in adults: clinical evaluation.  Clin Orthop. 1987;  224 215-223
  • 18 Nowinski R J. et al . Comminuted fracture - dislocations of the elbow treated with an AO wrist fusion plate.  Clin Orthop. 2000;  378 238-244
  • 19 Panayiotis J. et al . Treatment of non-union of olecranon fractures.  J Bone Joint Surg [Br]. 1994;  76 627-635
  • 20 Prayson M J. et al . Biomechanical comparison of fixation methods in transverse olecranon fractures: A cadaveric study.  J Orthop Trauma. 1997;  11 565-572
  • 21 Rettig A C, Waugh T R, Evanski P M. Fracture of the olecranon: A problem of management.  J Trauma. 1979;  19 23
  • 22 Romero J M, Miran A, Jensen C L. Complications and re-operation rate after tension-band wiring of olecranon fractures.  J Orthop Sci. 2000;  5 318-320
  • 23 Simpson N S, Goodman L A, Jupiter J B. Contoured LCDC plating of the proximal ulna.  Injury. 1996;  27 411-417
  • 24 Spencer A, Rowland M S. Tension band wiring of olecranon fractures. A modification of the AO Technique.  Clin Orthop Rel Res. 1989;  277 238-242
  • 25 Weber B G, Vesey H. Osteosynthese bei Olecranonfractur.  Z Unfallmed Berufskr. 1963;  2 90-96
  • 26 Wissing J C, van der Werken C. Die Zuggurtungsosteosynthese aus resorbierbarem Material.  Der Unfallchirurg. 1991;  94 45-46
  • 27 Wolfgang G. et al . Surgical treatment of displaced olecranon fractures by tension band wiring technique.  Clin Orthop. 1987;  224 192-204

Dr. med. Jonas Gehr

Abteilung Unfall-, Hand- und Wiederherstellungschirurgie · Klinikum Aschaffenburg

Am Hasenkopf 1

63739 Aschaffenburg

Germany

Telefon: +49/60 21/3 20

eMail: jondra@web.de