Determining the Efficacy of Screw and Washer Fixation as a Method for Securing Olecranon Osteotomies Used in the Surgical Management of Intraarticular Distal Humerus Fractures

Woods, Barrett I.; Rosario, Bedda L.; Siska, Peter A.; Gruen, Gary S.; Tarkin, Ivan S.; Evans, Andrew R.

doi:10.1097/bot.0000000000000131

Cited by 34 publications

(53 citation statements)

References 19 publications

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“…While intramedullary screw fixation is commonly used to fix olecranon osteotomies [13,14] fewer reports have been published on its use for simple (Mayo type I or IIA) olecranon fractures (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Intramedullary screw fixation for simple displaced olecranon fractures

Bosman

Emmink

Bhashyam

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Olecranon fractures are common and typically require surgical fixation due to displacement generated by the pull of the triceps muscle. The most common techniques for repairing olecranon fractures are tension-band wiring or plate fixation, but these methods are associated with high rates of implant-related soft-tissue irritation. Another treatment option is fixation with an intramedullary screw, but less is known about surgical results using this strategy. Thus, the purpose of this study was to report the clinical and functional outcomes of olecranon fractures treated with an intramedullary cannulated screw. Methods We identified 15 patients (average age at index procedure 44 years, range 16-83) with a Mayo type I or IIA olecranon fracture who were treated with an intramedullary cannulated screw at a single level 2 trauma center between 2012 and 2017. The medical record was reviewed to assess radiographic union, postoperative range of motion and complications (including hardware removal). Patient-reported outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Average follow-up was 22 months (range 8-36 months). Results By the 6th month post-operative visit, 14 patients had complete union of their fracture and 1 patient had an asymptomatic non-union that did not require further intervention. Average flexion was 145° (range 135-160) and the average extension lag was 11° (range 0-30). Implants were removed in 5 patients due to soft-tissue irritation. Average DASH score (± standard deviation) by final follow-up was 16 ± 10. Conclusions Fixation of simple olecranon fractures with an intramedullary screw is a safe and easy fixation method in young patients, leading to good functional and radiological results. Compared to available data, less hardware removal is necessary than with tension-band wiring or plate fixation.

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Section: Introductionmentioning

confidence: 99%

Intramedullary screw fixation for simple displaced olecranon fractures

Bosman

Emmink

Bhashyam

et al. 2019

Eur J Trauma Emerg Surg

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“…Various research groups analyzed the loading characteristics of different osteosyntheses techniques for olecranon osteotomies (10,11,18,19). A stable osteosynthesis seems best achieved by using either a cancellous screw plus tension band wiring or only tension band wiring.…”

Section: Discussionmentioning

confidence: 99%

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

Hess

Bürki

Moor

et al. 2020

Preprint

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Background: A tension band wiring technique is the current gold standard for osteosynthesis of olecranon osteotomies, although the technique has several practical disadvantages and its theoretical advantages have been questioned. The Step-Cut Olecranon osteotomy is an interesting new option for surgeons to access distal intra-articular humerus fractures, but its stability has only been assessed using the tension band wiring osteosynthesis. Therefore, the mean load to failure of this osteotomy with two different osteosynthesis techniques (tension band wiring and compression screws) was assessed. A higher load to failure was hypnotized for the tension-band-wiring osteosynthesis group. Methods: A Step-Cut Olecranon osteotomy was performed on 32 Sawbones. Half were secured by a tension band wiring and the other half by two compression screws. The humero-ulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna model, while the joint is in a fixed position. Eight models of each group were tested at one of two angles (20° and 70° of flexion) by isometrical loading until failure. A failure was defined as either complete fracture or gap formation of more than 2mm between osteotomy and the remaining model. Results: At 20° of flexion, the mean load to failure in the tension band wiring group was 1360 N (SD 238) and 1401 N (SD 261) in the compression screw group. At 70° of flexion, it was 1398 N (SD 215) and 1614 N (SD 427), respectively. Differences did not reach significance (p = 0.88 at 20°, p = 0.28 at 70°).Conclusions: A tension band wiring osteosynthesis does not provide higher stability than a compression screw osteosynthesis for the Step-Cut Olecranon osteotomy. A Step-Cut Olecranon osteotomy with screw osteosynthesis might be an interesting option for surgeons when treating intra-articular distal humeral fractures.

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“… 6 Woods et al compared different fixation methods for olecranon osteotomy after distal humerus fracture and concluded that age, sex and Charlson comorbidity index were related to nonunion and implant removal after olecranon osteotomy. 23 …”

Section: Discussionmentioning

confidence: 99%

Bicolumnar 90–90 plating of AO 13C type fractures

Kural

Erçin

Erkilinç

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to evaluate functional results and complication rate of patients who underwent medial-dorsolateral plating for intra-articular distal humeral fracture (Müller AO type 13C).MethodsTwenty-four patients (14 men, 10 women; mean age: 47 years) with AO type 13C distal humerus fracture were included in the study. Mean follow-up time was 28 months. Nine patients were in 13C1 subgroup, according to AO classification system, 11 patients were categorized as 13C2, and 4 patients were 13C3. Final follow-up assessment of outcomes included Broberg and Morrey radiological criteria; Mayo Elbow Performance Score, disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure, score based on Jupiter criteria; and range of motion (ROM) values.ResultsThe mean carrying angle of operated elbows was 11.37° (range: 0-20°). According to Broberg and Morrey radiological criteria, 14 patients, had radiologically normal elbow, 4 patients had mild change, 3 patients had moderate change, and 3 patients had severe radiological change. Mean DASH score was 21.91 (range: 0-50), and mean Mayo rating was 83.37 (range: 55-100). Jupiter criteria evaluation revealed excellent results in 10 cases, good in 12, and fair results in 2. One patient with fair result had open fracture, and the other had previous hemiparesis in the same extremity. There was no instance of nonunion observed at follow-up.ConclusionOsteosynthesis with medial-dorsolateral plating is a safe and effective method for the treatment of intra-articular fractures of distal humerus.Level of evidenceLevel IV, Therapeutic study.

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Determining the Efficacy of Screw and Washer Fixation as a Method for Securing Olecranon Osteotomies Used in the Surgical Management of Intraarticular Distal Humerus Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 34 publications

References 19 publications

Intramedullary screw fixation for simple displaced olecranon fractures

Intramedullary screw fixation for simple displaced olecranon fractures

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

Bicolumnar 90–90 plating of AO 13C type fractures

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