Compression Screw Fixation for Pediatric Olecranon Fractures

Abstract

Background: Pediatric olecranon fractures can be treated with several methods of fixation. Though postoperative outcomes of various fixation techniques, including cannulated intramedullary screws, have been described in adults, functional and radiographic outcomes of screw fixation in pediatric patients are unclear. In this study, we assessed clinical, radiographic, functional, and patient-reported outcomes of pediatric olecranon fractures treated with compression screw fixation. Methods: We retrospectively identified 37 patients aged 16 years or younger with a total of 40 olecranon fractures treated with screw fixation at our level-1 trauma center between April 2005 and April 2022. From medical records, we extracted data on demographic characteristics, time to radiographic union, range of elbow motion at final follow-up, and complications during the follow-up period. Patient-reported outcomes were evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Reported Outcomes Measurement Information System Pediatric Upper Extremity Short Form 8a measures. Results: There were no malunions or nonunions at the final mean follow-up of 140 days (range, 26 to 614 d). Four patients had implant failure (11%), of whom 3 experienced fracture union with no loss of fixation or need for revision surgery. One patient underwent a revision for fracture malreduction. Screw prominence was documented in 1 patient. Instrumentation was removed at our institution for 33 of 40 fractures. Mean time to radiographic union was 53 days (range, 20 to 168 d). Postoperative range of motion at the most recent follow-up visit showed a mean extension deficit of 6 degrees (range, 0–30 degrees) and mean flexion of 134 degrees (range, 60–150 degrees). At the final follow-up, the mean (±SD) Quick Disabilities of the Arm, Shoulder, and Hand score was 4.2±8.0, and the mean Patient-Reported Outcomes Measurement Information System score was 37±1.5, indicating good function and patient satisfaction. Conclusions: All 37 patients in our series had excellent radiographic, functional, and patient-reported outcomes after screw fixation. We observed no cases of nonunion or malunion, growth disturbance, or refracture. These results suggest that screw fixation is a safe and effective option for pediatric olecranon fractures. Level of Evidence: Level IV, case series.

Outcomes of olecranon fractures in adolescents: comparison of tension band wiring and Herbert screw fixations

“…Ulnar olecranon epiphyseal ossification centers appear at 9–11 years of age and begin to heal with the ulnar shaft around the age of 17 years, whereas 15% of the ulna growth depends on the proximal growth plate, and the growth rate drops to 5% by the age of 8 years ( 18 ). In recent years, some researchers have applied screws to ulnar olecranon fractures in healthy children ( 9 , 19 ) and achieved a clinical efficacy similar to that of tension band wires. Bilateral AP and lateral radiographs were examined after 6 months to study the effect of screws on premature epiphyseal closure and extremity length.…”