Arch Hand Microsurg.  2021 Mar;26(1):18-26. 10.12790/ahm.20.0078.

Surgical Treatment of Comminuted Olecranon Fracture Using Locking Compression Plate Fixation

• Lee E
• Cho SH
• Yoo JI
• Im JH
• Kang DG
• Park JS

• KMID: 2513202
• DOI: http://doi.org/10.12790/ahm.20.0078

Abstract

Purpose
Several types of surgical methods from tension band wiring to plate fixation are used in olecranon fractures. In comminuted olecranon fractures, plate fixation is recommended as it is difficult to obtain stable fixation of the bone fragments and joint congruency. The authors performed operations using compression locking plate for olecranon fractures corresponding to Mayo classification IIB and IIIB, and report the radiologic and functional results.
Methods
Twenty-one patients who underwent plate fixation surgery for comminuted olecranon fractures at our hospital from September 2011 to April 2019 were enrolled in this study. Patients were retrospectively analyzed for at least 1 year. The classification of olecranon fracture was performed using the Mayo classification. For the analysis of the postoperative results, radiological union time, postoperative range of motion, complications, and functional results based on Mayo elbow performance score (MEPS) were evaluated.
Results
The union was achieved in all cases and three posttraumatic arthritis were observed at the final follow-up. The average range of motion was 134.3° in flexion, –9.8° in extension. The mean MEPS was 93.1. There was no statistically significant difference in MEPS between the group that used technique of interfragmentary fixation and the group that did not (p=0.534).
Conclusion
Surgical treatment using a locking compression plate fixation in comminuted olecranon fracture resulted in excellent functional results. Restoration of articular surface using Kirschner wire or interfragmentary screw between small bone fragments is considered a useful method for obtaining good functional results.

Keyword

Olecranon fracture; Locking compression plate; Interfragmentary fixation

Figure

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  Fig. 1. Intraoperative photo shows Kirschner wire tips (arrowheads) for interfragmentary fixation of articular fragments (A). Lateral radiographs present a satisfactory reduction of articular surface with interfragmentary fixation (B).

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  Fig. 2. Radiographs of the severe comminuted fracture of left olecranon due to industrial injury in a 60 year-old man (case 11). (A) Anteroposterior view. (B) Lateral view.

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  Fig. 3. Radiographs after emergency surgery with external fixation and temporary fixation of articular fragments. (A) Anteroposterior view. (B) Lateral view.

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  Fig. 4. Radiographs after conversion open reduction and internal fixation with plate, interfragmentary screw fixation and cerclage wiring. Radiographs (A, anteroposterior view; B, lateral view) show satisfactory reduction of articular congruency.

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  Fig. 5. At 18 months after conversion open reduction and internal fixation, radiographs (A, anteroposterior view; B, lateral view) show the remnant headless compression screw for articular fragment fixation and minimal posttraumatic arthritis of ulnohumeral joint.

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  Fig. 6. At 18 months after surgery, clinical pictures present no significant limitation of elbow motion of patient. (A) Flexion of elbow, (B) extension of elbow, and (C) 15° of flexion contracture of the injured elbow.

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  Fig. 7. Radiographs (A, anteroposterior view; B, lateral view) show a comminuted fracture of the right elbow in a 19-year-old male patient (case 20). (C) Three-dimensional computed tomography images present severe comminution of olecranon fracture including articular surface.

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  Fig. 8. At 1 year after surgery, radiographs (A, anteroposterior view; B, lateral view) show the satisfactory reduction of ulnohumeral joint using the plate and screws with intrefragmentary fixation.

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