Title: Precontoured Plate Fixation in Fracture Olecranon in Adults

Authors: Nishit Kumar Singh, Partap Singh, Kuldeep Malik, Himanshu Agrahari, Sandeep Chauhan

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.121

Abstract

Introduction: Olecranon process is a large, curved eminence comprising of the proximal and posterior part of the ulna. It lies subcutaneously which makes it more vulnerable to injury. Due to intra-articular extension of fractures, anatomical reduction and early mobilization should be achieved in every case.

Aims and Objectives: To evaluate the results of precontoured LCP in fracture olecranon and to achieve union in fracture olecranon.

Materials and Methods: This was a prospective study consisted of 25 cases of olecranon fractures which were managed by open reduction and internal fixation using Precontoured locking compression plate (LCP). Patients were followed up every month till 6 months. Final assessment was done at 6 months using the Mayo Elbow Performance Score.

Results: According to the Mayo classification, 20 fractures were type II and 5 type I. An adequate reduction was maintained in all elbows until union. The MEPS-rated outcome was 19(76%) excellent, 4(16%) good and 2(8%) fair with best result in 20-29 yr age group. 2(8%) patient develop superficial infection which was treated with broad spectrum antibiotic and wound dressings and 6(24%) patient develop symptomatic metal prominence which is managed with implant removal.

Conclusion: open reduction and internal fixation with precontoured LCP is based on sound biomechanical principle with a good functional outcome and a low incidence of complications.

References

  1. Veillette CJH, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008;39(2):229–36.
  2. Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of fractures of the proximal ulna. Injury 2012;43(3):343-6.
  3. Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. JBJS. 1995 ;77(2):316-27.
  4. Müller ME, Allgöwer M. Manual of internal fixation: techniques recommended by the AO-ASIF group(ed 3) Berlin Germany, Springer Verlag, 1991.
  5. Waddell G, Howat TW. A technique of plating severe olecranon fractures. Injury 1973;5:135–40.
  6. Anderson ML, Larson AN, Merten SM, Steinmann SP. Congruent elbow plate fixation of olecranon fractures. Journal of orthopaedic trauma. 2007 Jul 1;21(6):386-93.
  7. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. Journal of orthopaedic trauma. 2001 Nov 1;15(8):542-8.
  8. Hume MC, Wiss DA. A Clinical and Radiographic Comparison of Tension Band Wiring and Plate Fixation. Clinical orthopaedics and related research. 1992 Dec 1;285:229-35.
  9. King GJ, Lammens PN, Milne AD, Roth JH, Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. Journal of shoulder and elbow surgery. 1996 Nov 1;5(6):437-41.
  10. Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. JBJS. 1995 Feb 1;77(2):316-27.
  11. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488–93.
  12. Perren SM. Point contact fixator: Part I. Scientific background, design and application. Injury 1995;22(1):1-10.
  13. Cabanela ME. Fractures of the proximal ulna and olecranon. The elbow and its disorders. 1993:405-28.
  14. Scharplatz D, Allgöwer M​.Fracture-dislocations of the elbow. Injury 1975;7:143-59.
  15. Molloy S, Jasper LE, Elliott DS, Brumback RJ, Belkoff SM. Biomechanical evaluation of intramedullary nail versus tension band fixation for transverse olecranon fractures. Journal of Orthopaedic Trauma 2004;18 (3):170-4.
  16. Khann G. A comparative study of tension band wiring and reconstruction plating in olecranon fractures. Pb Am J Orthop. 2012;8(1):57-61.
  17. Munoz-Mahamud E, Fernandez-Valencia JA, Riba J. Plate osteosynthesis for severe olecranon fractures. Journal of Orthopaedic Surgery 2010;18(1):80-4.
  18. Kloen P, Buijze GA. Treatment of proximal ulna and olecranon fractures by dorsal plating. Operative Orthopädie und Traumatologie 2009;21(6):571-85.
  19. Cervera-Irimia J, Tomé-Bermejo F, Gómez-Bermejo MA, Holgado-Moreno E, Stratenweth EG. Treatment of comminuted olecranon fractures with olecranon plate and structural iliac crest graft. Acta Orthop Belg. 2012;78:703.
  20. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. Journal of orthopaedic trauma. 2001 Nov 1;15(8):542-8.

Corresponding Author

Nishit Kumar Singh

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