Management of comminuted fractures of the olecranon by tension band wiring.

Department of Orthopaedic Surgery, Ayub Medical College, Abbottabad.
Journal of Ayub Medical College, Abbottabad: JAMC 01/2009; 15(3):27-9. DOI: 10.1097/BTH.0b013e31819225dc
Source: PubMed

ABSTRACT Open reduction and rigid internal fixation has become the generally accepted method of treatment for displaced fractures of the olecranon in order to allow early mobilisation and to prevent contracture of the elbow. Comminuted fractures of olecranon are unstable, therefore, bone graft and tension band wiring are supposed to give good stability. Here we give an account of our experience with this procedure.
We treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest between 1999 and 2002 at Ayub Teaching Hospital, Abbottabad. After initial immobilization strengthening and endurance exercises were started. The patients were followed up for stability, muscle strength, active range of flexion and extension at elbow and rotation of forearm.
The time to union of the fractures was 3 to 7 months. No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The median flexion was up to 135 degrees (125 degrees to 145 degrees) with a median flexion contracture of 15 degrees (range 10 degrees to 30 degrees). The median pronation was 70 degrees (60 degrees to 80 degrees) and median supination 79 degrees (70 degrees to 90 degrees). Only three patients had mild pain and loss of strength. Five patients had excellent and 5 good results with a median Broberg and Morrey index score of 94.5 points (84 to 100).
Our results are in accordance with those reported from other centres and the technique is thought to be a practical alternative to plate fixation of olecranon fractures with extreme comminution.

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    ABSTRACT: In order to improve initial operative treatment of complex olecranon fractures we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment. 80 patients operated with diagnosis of complex olecranon fracture were identified in an 8-year-period from trauma unit files at two European Level 1 Trauma Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified patients with concomitance of an intermediate fragment. The Patient-Rated Elbow Evaluation Score was calculated for 45 of 80 patients at a minimum of 8 months postoperatively (range 8-84 months). 29 patients were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 patients with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 patients. In 29 of these 52 patients, the intermediate fragment was described in operative report. 24 of these 29 patients were treated with posterior plate osteosynthesis, and 5 patients with figure-of-eight tension band wiring. Complications included superficial infection (2 patients), secondary dislocation (3 patients) and heterotopic ossifications (1 patient). Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 patients. An extraordinary amount of patients showed an intermediate fragment. Consideration, desimpaction and anatomic reduction of the intermediate fragment are necessary preconditions for anatomic restoration of the trochlear notch. There is no clear benefit for plating versus tension band wiring according to our data. In the operative report precise description of the fracture pattern including presence of an intermediate fragment is recommended.
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    ABSTRACT: Various methods are used to treat comminuted fractures of the olecranon. The preferred method of management of fractures of the olecranon is tension band wiring over K-wires. Often, it becomes difficult to fix small articular fragments with the 2 K-wires used for tension band wiring. Since 2005, we have used the missing K-wire technique to fix the small articular fragments.
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