Introduction and objectives: This is a complex type of lesion that is frequently confused with Monteggia fracture. The objective of this paper is to analyse the experience of the Hospital Cl co San Carlos, in Madrid, in the management of the transolecranon fracture-dislocation of the elbow.

Methods and material: Between 1988 and 2001 a total of 23 cases have been revised, 7 of them presenting an oblique simple fracture of the olecranon and the other 16 cases with a comminute one (with fracture of the coronoid process in 9 patients). There was also a radial head fracture associated in 7 patients. Two cases showed ulnar nerve palsy before surgery. Fifthteen of the 21 cases were males and 8 females, with a mean age of 37, 3 years (range: 17–71). The mean follow up was of 56 months (range: 22–122 months). The etiology was a traffic accident (bicycle, motorbike, car) in the 47, 6%, a casual fall in the 23, 8%, a sport accident in the 14, 2% and a precipitation in the 9, 5%. All of them were treated with open reduction and internal fixation, with plate and screws in 17 cases and tension-band wiring in 4 patients. When a radial head fracture was associated, reconstruction was performed with screws in 5 cases and radial head excision in 1 case. Anatomic reduction was achieved in 11 cases.

Results: With the scale of Broberg and Morrey, excellent result was obtained in 6 cases, good in 8, fair in 6, and poor in the remaining 3. The most frequent complication was loss of motion (6 cases), followed by non-union in 2 cases (with hardware fatigue failure in 1 of them) and infection in other case. The two cases with preoperative ulnar nerve palsy resolved over a period of 4 months. Eleven patients needed a reoperation, performing a new internal fixation with bone grafting in 2 cases, a radial head prosthesis implanting in 1 case, and hardware removal in 8 cases.

Discussion and Conclusions: Although the transolecra-non fracture-dislocation of the elbow can be included in several classifications (AO, de Cotton, de Schatzker, etc.), none of them accommodate it satisfactorily, because of the complexity of the lesion. Our results show a statistically significative relation (p < 0.05) between the anatomic reduction obtained and excellent or good results and a high frequency of joint stiffness in this severe lesion.

Aims: To compare retrospectively the results of percutaneous þxation, open reduction and þxation and hemi-arthroplasty in displaced proximal humerus fractures. Methods: The initial study group lost 29.50% of patients to follow-up and registered 14.75% deaths. Finally, 98 patients came back for revision and were included in the study with an average follow-up of 41 months. The hemi-arthroplasty group (H) included 34 patients, the percutaneous group (P) 32 and the internal þxation (I) 32. The average age was 55 for P group, 58 for I and 72 for H. Females represented 62% of P, 50% of I and 79% of H. Low energy fractures accounted for 62%, 63% and 78% respectively. Comorbidity in H was present in 50% of cases and associated fractures in 28%. Three and four part fractures following Neer classiþcation were present in 55% P, 55% for I and 100% for H. Results: Average elevation was 130û for P, 106û for I and 80û for H patients. Selecting only three and four part fractures, elevation was 105û in P, 104û in I and 80û in H. Constant score reached in average 81 points in P, 68 in I and 57 in H. For three and four part patients mean Constant was 74, 68 and 57 respectively. VAS with daily activities was 0.6 for P, 2.3 for I and 3.8 for H. Good and average radiological reduction was achieved in 55% of P and I groups and 12.5% osteonecrosis developed in I but none in P. Conclusions: Percutaneous þxation represents a good surgical option comparable to open reduction and þxation. Hemiarthroplasty only achieves modest functional results but patients have quite different epidemiological data.