Olecranon fractures: treatment options

Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion. Open reduction and internal fixation...

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Published inJournal of the American Academy of Orthopaedic Surgeons Vol. 8; no. 4; p. 266
Main Authors Hak, D J, Golladay, G J
Format Journal Article
LanguageEnglish
Published United States 01.07.2000
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Abstract Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion. Open reduction and internal fixation is the standard treatment for displaced intra-articular fractures. Stable internal fixation with figure-of-eight tension-band wire fixation for simple transverse fractures allows early motion to minimize stiffness. Use of two knots produces symmetric tension at the fracture site and provides more rigid fixation than a single knot. Care should be taken to ensure that the tension-band wire and the proximal ends of the Kirschner wires are positioned deep to the triceps fibers to prevent wire migration. If the anterior cortex is engaged, overpenetration of the wires into the soft tissues should be avoided. Plate fixation is appropriate for severely comminuted fractures, distal fractures involving the coronoid process, oblique fractures distal to the midpoint of the trochlear notch, Monteggia fracture-dislocations of the elbow, and nonunions. For comminuted fractures and nonunions, a dorsally applied limited-contact dynamic-compression plate with supplemental bone graft should be utilized to support comminuted depressed articular fragments. A one-third tubular hook-plate can be used for fractures with a small proximal fragment for which additional fixation of the olecranon tip is desired. Fragment excision and triceps advancement is appropriate in selected cases in which open reduction seems unlikely to be successful, such as in osteoporotic elderly patients with severely comminuted fractures.
AbstractList Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion. Open reduction and internal fixation is the standard treatment for displaced intra-articular fractures. Stable internal fixation with figure-of-eight tension-band wire fixation for simple transverse fractures allows early motion to minimize stiffness. Use of two knots produces symmetric tension at the fracture site and provides more rigid fixation than a single knot. Care should be taken to ensure that the tension-band wire and the proximal ends of the Kirschner wires are positioned deep to the triceps fibers to prevent wire migration. If the anterior cortex is engaged, overpenetration of the wires into the soft tissues should be avoided. Plate fixation is appropriate for severely comminuted fractures, distal fractures involving the coronoid process, oblique fractures distal to the midpoint of the trochlear notch, Monteggia fracture-dislocations of the elbow, and nonunions. For comminuted fractures and nonunions, a dorsally applied limited-contact dynamic-compression plate with supplemental bone graft should be utilized to support comminuted depressed articular fragments. A one-third tubular hook-plate can be used for fractures with a small proximal fragment for which additional fixation of the olecranon tip is desired. Fragment excision and triceps advancement is appropriate in selected cases in which open reduction seems unlikely to be successful, such as in osteoporotic elderly patients with severely comminuted fractures.
Author Golladay, G J
Hak, D J
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/10951115$$D View this record in MEDLINE/PubMed
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Snippet Fractures of the olecranon process of the ulna typically occur as a result of a motor-vehicle or motorcycle accident, a fall, or assault. Nondisplaced...
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StartPage 266
SubjectTerms Biomechanical Phenomena
Bone Plates
Bone Screws
Casts, Surgical
Elbow Joint - injuries
Fracture Fixation, Internal - instrumentation
Fracture Fixation, Internal - methods
Fracture Healing
Fractures, Bone - classification
Fractures, Bone - diagnosis
Fractures, Bone - etiology
Fractures, Bone - therapy
Humans
Patient Selection
Postoperative Care - methods
Range of Motion, Articular
Risk Factors
Treatment Outcome
Title Olecranon fractures: treatment options
URI https://www.ncbi.nlm.nih.gov/pubmed/10951115
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