J Korean Orthop Assoc.  2011 Apr;46(2):146-151.

A Retrospective Comparative Study of Internal Fixation with Contoured Plate Using Bicortical Screw Versus a Double Plate in Comminuted Olecranon Fractures

• Kim BK
• Shin HD
• Kim KC
• Jeon YS

Abstract

PURPOSE
To analyze the clinical result of a contoured plate fixation using a bicortical screw and a double plate fixation in the surgical treatment of an adult's comminuted olecranon fracture.
MATERIALS AND METHODS
A total of 22 patients were classified by Mayo classification as Type IIB (17) and Type IIIB (5). All patients enrolled in the study were treated between July 2002 and September 2009. Twelve patients were operated on using the contoured plate internal fixation using a bicortical screw procedure classified as group 'A'. The 10 patients operated on by a double plate fixation were classified as group 'B'. The Mayo elbow performance score was used to compare postoperative clinical results based on total points in 4 categories: pain, range of motion, articular stability, and articular function.
RESULTS
The clinical results of using the Mayo elbow performance score of group 'A' were that 10 scored in the 'excellent' range and 2 scored in the 'good' range the following: in group 'B' were in the excellent range and 3 were in the good range. Both groups showed satisfactory results. Postoperative elbow exercises in group 'A' commenced 7.8 (5-14) days on average, postoperatively. For 'B' group, post-operative elbow exercises began 4.5 (3-7) days following the operation. With regard to the exercise and the range of elbow motion, group 'A' averaged 113.5 degrees and group 'B' averaged 112 degrees. After surgery, the average durations until the bone union were 3.8 (2.4-5.6) months for group 'A' and 4 (2.5-5) months for group 'B', respectively.
CONCLUSION
There was no significant difference in the clinical results between patients treated with the contoured plate internal fixation using a bicortical screw or the internal fixation using a double plate in the surgical treatment of adults with comminuted olecranon fracture or dislocation. Therefore, both types of operative approach are acceptable.

Keyword

comminuted olecranon fracture; bicortical screw; contoured plate; double plate

MeSH Terms

Adult
Dislocations
Elbow
Exercise
Humans
Olecranon Process
Range of Motion, Articular
Retrospective Studies

Figure

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  Figure 1 (A) Preoperative simple radiograph shows Mayo type IIB olecranon fracture. (B) The fracture was fixed by contoured plate using bicortial screws internally. (C) At 12 months after surgery, simple radiographs show solid union of fracture site and no loosening of plate.

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  Figure 2 (A) Preoperative simple radiograph shows Mayo type IIIB olecranon fracture. (B) The fracture was fixed by double plates internally. (C) At 12 months after surgery, follow-up radiographs show rigid fixation.

Reference

1. Coonrad RW. Morrey BF, editor. Management of olecranon fractures and nonunion. The elbow. Mater techniques in orthopaedic surgery. 1994. New York: Raven Press;1–95.

2. Horne JG, Tanzer TL. Olecranon fractures: a review of 100 cases. J Trauma. 1981. 21:469–472.

3. Larsen E, Lyndrup P. Netz or Kirschner pins in the treatment of olecranon fractures? J Trauma. 1987. 27:664–666.

4. Gartsman GM, Sculco TP, Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg Am. 1981. 63:718–721.

5. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000. 8:266–275.

6. Lee JM, Park JH. Fractures of the olecranon of ulna treated by plating and tension-band wiring technique. J Korean Soc Fract. 1996. 9:801–808.

7. Shin HD, Yang JH, Kim PS. Internal fixation using double plates for comminuted olecranon fractures in adults. J Korean Fract Soc. 2009. 22:166–171.

8. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am. 2009. 91:2416–2420.

9. Boyer MI, Galatz LM, Borrelli J Jr, Axelrod TS, Ricci WM. Intra-articular fractures of the upper extremity: new concepts in surgical treatment. Instr Course Lect. 2003. 52:591–605.

10. Fyfe IS, Mossad MM, Holdsworth BJ. Methods of fixation of olecranon fractures. An experimental mechanical study. J Bone Joint Surg Br. 1985. 67:367–372.

11. Horner SR, Sadasivan KK, Lipka JM, Saha S. Analysis of mechanical factors affecting fixation of olecranon fractures. Orthopedics. 1989. 12:1469–1472.

12. Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res. 1992. (285):229–235.

13. Nork SE, Jones CB, Henley MB. Surgical treatment of olecranon fractures. Am J Orthop (Belle Mead NJ). 2001. 30:577–586.

14. King GJ, Lammens PN, Milne AD, Roth JH, Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. J Shoulder Elbow Surg. 1996. 5:437–441.

15. O'Driscoll SW. Technique for unstable olecranon fracture-subluxations. Oper Tech Orthop. 1994. 4:49–53.

16. Gordon MJ, Budoff JE, Yeh ML, Luo ZP, Noble PC. Comminuted olecranon fractures: a comparison of plating methods. J Shoulder Elbow Surg. 2006. 15:94–99.

17. Bryan RS. Fractures about the elbow in adults. Instr Course Lect. 1981. 30:200–223.

18. Eriksson E, Sahlin O, Sandahl U. Late results of conservative and surgical treatment of fracture of the olecranon. Acta Chir Scand. 1957. 113:153–166.