J Korean Fract Soc.  2015 Jan;28(1):30-37. 10.12671/jkfs.2015.28.1.30.

Olecranon Nonunion after Operative Treatment of Fracture

• Kang HJ
• Kim JS
• Shin MH
• Koh IH
• Choi YR

• KMID: 1774094
• DOI: http://doi.org/10.12671/jkfs.2015.28.1.30

Abstract

PURPOSE
Olecranon nonunion after surgical management is relatively rare, but it leads to limitation of motion of joint or instability. This retrospective study was conducted in order to analyze the cause and result of treatment.
MATERIALS AND METHODS
We analyzed 11 cases treated for nonunion of olecranon fractures. Nonunion was classified according to the spot of the lesion and the extent of articular surface damage. Evaluation was performed using Mayo elbow performance score (MEPS), Oxford elbow score (OES), Disabilities of the Arm, Shoulder and Hand (DASH) scores, and the range of motion.
RESULTS
According to the spot of the lesion and the extent of articular surface damage, nonunion was categorized as IA (2 cases), IIA (5 cases), and IIIA (4 cases). One case of IA underwent nonunion fragment excision and the remaining cases were treated by bone grafting. A plate was used in seven cases and the other three cases had both plate and tension band wiring fixation. All nonunions finally became union. The 11 patients with one year follow-up had average MEPS of 87.7 points (range: 60-100 points), average OES of 43.2, and average DASH score of 18.8 points. Complications included limitation of motion (2 cases) and ulnar nerve symptoms (3 cases).
CONCLUSION
Bone grafting and fixation by plate may be beneficial. In addition, excision can be useful in type I.

Keyword

Olecranon; Nonunion

MeSH Terms

Arm
Bone Transplantation
Elbow
Follow-Up Studies
Hand
Humans
Joints
Olecranon Process*
Range of Motion, Articular
Retrospective Studies
Shoulder
Ulnar Nerve

Figure

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  Fig. 1 Classification of olecranon nonunions.

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  Fig. 2 (A) Lateral radiograph of a 69-year-old man after tension band wiring. (B) At 7 months after surgery, lateral radiograph shows nonunion of olecranon and pull out of tension band wiring (white arrow). (C) At 3 months after curettage and internal fixation with a reconstruction plate, radiograph shows union.

• 

  Fig. 3 (A) Lateral radiograph of a 53-year-old man shows a comminuted olecranon fracture. (B) At 7 months after surgery, lateral radiograph shows nonunion of olecranon, inadequate reduction and malposition of the proximal screw after plate fixation. (C) Osteosynthesis with plate fixation and auto-iliac bone graft. At 9 months after surgery, the patient was pain-free, had a range of motion greater than 90°.

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  Fig. 4 (A) Lateral radiograph of a 30-year-old man shows inadequate mechanical stability and failure of fixation with screws. (B) Osteosynthesis with plate fixation and autoiliac bone graft. (C, D) At 14 months after surgery, radiograph shows union. (E, F) Active range of motion 14 months after surgery.

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  Fig. 5 (A) Initial radiograph of a 46-year-old man shows a distal humerus fracture. (B) At 9 months after open reduction and internal fixation with double plating through olecranon osteotomy, radiograph shows non-union of olecranon after tension band wiring. (C) Excision of the olecranon fragment and advancement of the triceps tendon. (D) At 5 months after second surgery, active range of motion greater than 90° and painless elbow were achieved. (E, F) Active range of motion 1 year after hardware removal.

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