J Korean Orthop Assoc.  2016 Oct;51(5):403-410. 10.4055/jkoa.2016.51.5.403.

Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna

• Byun SE
• Lee HJ
• Kim J
• Lee SJ
• Kim U
• Han SH

• KMID: 2355505
• DOI: http://doi.org/10.4055/jkoa.2016.51.5.403

Abstract

PURPOSE
Bifocal fracture of the proximal ulna is a fracture of the olecranon accompanied by fracture of the coronoid process. The purpose of the current study was to analyze the clinical results of the author's technique in bifocal fracture of the proximal ulna.
MATERIALS AND METHODS
Fifteen patients (10 men, 5 women) treated at CHA Bundang Medical Center from April 2006 to October 2014 were analyzed retrospectively. All patients underwent internal fixation using a locking compression plate (LCP) with retrograde screw fixation of the coronoid process through a screw hole of the plate. Mean age of the patients was 42.6 years and the mean follow-up period was 18.6 months. Comminuted coronoid fractures with hard to screw fixation, complex injuries combined with open damage, and complete ligament rupture were excluded. Fracture union and articular congruity were examined on the follow-up radiographs. Range of motion, disability of the arm, shoulder and hand (DASH) score, and Mayo elbow performance score were evaluated for functional analysis.
RESULTS
Fracture union was achieved and articular step off was less than 2 mm in all patients on the follow-up radiographs. The mean value of modified Mayo elbow score was 92.14 (80-100) and DASH score was 7.11 at last follow-up. The mean range of motion of elbow was 128o. There was one case of small heterotopic ossification as a radiographic complication which had no functional deficit.
CONCLUSION
Internal fixation of bifocal multifragmentary articular fractures of the proximal ulna with anatomically contoured LCP olecranon plate and retrograde long screws could be a recommendable surgical procedure. This study showed that the precontoured plate with retrograde coronoid process screw fixation can produce good clinical and radiographic outcomes in bifocal fractures of the proximal ulna. We recommend this procedure in this type of fracture.

Keyword

proximal ulna fracture; olecranon fracture; coronoid process fracture; internal fixation

MeSH Terms

Arm
Elbow
Follow-Up Studies
Hand
Humans
Ligaments
Male
Olecranon Process*
Ossification, Heterotopic
Range of Motion, Articular
Retrospective Studies
Rupture
Shoulder
Ulna*

Figure

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  Figure 1 Intraoperative view. (A) The olecranon was initially fixed with a 3.5 mm anatomically contoured locking compression plate. (B-D) After fixation of the olecranon, the gap of the coronoid process fragment was checked with using an image intensifier. In cases of more than 2 mm of gap, the coronoid process was indirectly reduced with using a bone hook and provisional fixation with K-wire was performed done. (E) Retrograde fixation of the coronoid process was performed done using a long screw through a screw hole of the plate.

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  Figure 2 Pre- and postoperative imaging study. (A, B) Comminuted olecranon fracture and associated coronoid process fracture were seen observed on anteroposterior and lateral view. (C, D) The anteroposterior and lateral view at 12 months after the operation show good healing of the fracture.

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  Figure 3 Postoperative photographs. The photographs show a good functional result of an injured elbow with nearly normal range of motion equivalent to non-injured elbow.

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  Figure 4 Pre- and postoperative radiographs. (A, B) Comminuted olecranon fracture and associated coronoid process fracture were seen observed on anteroposterior and lateral view. (C, D) The anteroposterior and lateral view at 18 months after the operation show good healing of the fracture.

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  Figure 5 Postoperative photographs. The photographs show a good functional result of an injured elbow with nearly normal range of motion equivalent to the non-injured elbow.

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