Abstract
Fixation of comminuted olecranon and proximal ulna fractures can be a challenge. The goal of surgery is for stable fixation to encourage union and allow early elbow movement.
Over a 3 year period, a low profile titanium, precon-toured olecranon plate (Acumed LLC, Hillsboro, Portland, Oregon) was used in 16 patients with comminuted olecranon and proximal ulna fractures, using a standard universal posterior approach to the olecranon with the patient in a lateral position and active flexion/extension of the elbow was started 48 hours postoperatively. Functional outcomes were measured during follow-up (FU), including range of movement (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS).
There were 9 isolated olecranon fractures, including one open fracture in a multiple injured patient and one an infected non-union and 7 with associated ipsilateral upper limb injuries. Mean age was 52 years (13 to 84) and mean FU was 12.8 months (3 to 33). All had achieved radiological union at 3 months. Overall mean ROM for both groups was 19.3 to 130.7 degrees flexion, 71.8 degrees pronation and 72.1 degrees supination. DASH was 19.1 and MEPS was 87.7.
When comparing the 2 groups, there was no significant difference in supination or pronation but all other mean outcomes measurements showed statistical significance in favour of isolated, comminuted olecranon fractures. Extension 9.4 versus 35.0 degrees (p< 0.005), Flexion 140.6 versus 117.5 (p< 0.05), DASH 7.5 versus 34.7 (p=0.0007) and MEPS 96.3 (excellent) versus 78.3 (good) (p< 0.05). There were no infections or failure of metalwork, but two patients had the metalwork removed after union as they required further surgery to their elbows.
We demonstrate this is a safe and reliable method of fixation and can expect excellent results when treating isolated comminuted olecranon/proximal ulna fractures and good results when there are associated ipsilateral injuries.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
