Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)

Chapleau, Julien; Balg, Frédéric; Harvey, Edward J.; Ménard, Jérémie; Vauclair, Frédéric; Laflamme, G. Yves; Hébert‐Davies, Jonah; Rouleau, Dominique M.

doi:10.1016/j.injury.2016.08.029

Cited by 22 publications

(21 citation statements)

References 28 publications

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“…Many reasons exist for differences between our study and existing literature [11,[15][16][17]. The prior studies are small and often include a wide variety of fractures treated with intramedullary screws, and frequently in settings where plate fixation would have been more appropriate given our greater understanding of proximal ulna fracture morphology 1 3 [19][20][21]. For example, in the series published by Helm et al, 79% of treated fractures were comminuted [17].…”

Section: Discussionmentioning

confidence: 94%

“…However, many of these studies are older without clear inclusion criteria or CT imaging. As we have learned more about the morphology of the ulna and proximal ulna fractures [19][20][21], it is less clear if early reports about the unreliability of intramedullary screw fixation were related solely to implant choice or to the use of an intramedullary screw for inappropriate (i.e., more complex) fracture types [22]. Thus, the purpose of this study was to assess the clinical and functional outcomes of simple olecranon fractures treated with an intramedullary cannulated screw.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 94%

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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“…56,57 An improper reconstruction and denial of the exact elbow anatomy may result in sequelae such as elbow instability, persistent pain and osteoarthritis. 54,55 In general, a precise evaluation of the fracture mechanism in respect to the resulting gravitational stresses is paramount to understand possible injuries and aid the surgeon in finding all anatomical mishaps.…”

Section: Anatomymentioning

confidence: 99%

Fractures of the proximal ulna: current concepts in surgical management

2019

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Fractures of the proximal ulna range from simple olecranon fractures to complex Monteggia fractures or Monteggia-like lesions involving damage to stabilizing key structures of the elbow (i.e. coronoid process, radial head, collateral ligament complex).In complex fracture patterns a computerized tomography scan is essential to properly assess the injury severity.Exact preoperative planning for the surgical approach is vital to adequately address all fracture parts (base coronoid fragments first).The management of olecranon fractures primarily comprises tension-band wiring in simple fractures as a valid treatment option, but modern plate techniques, especially in comminuted or osteoporotic fracture types, can reduce implant failure and potential implant-related soft tissue irritation.For Monteggia injuries, the accurate anatomical restoration of ulnar alignment and dimensions is crucial to adjust the radiocapitellar joint.Caution is advised if the anteromedial facet (anatomical insertion of the medial collateral ligament) of the coronoid process is affected, to avoid posteromedial instability.Radial head reconstruction or replacement is essential in Monteggia-like lesions to restore normal elbow function.The postoperative rehabilitation programme should involve active elbow motion exercises without limitations as early as possible following surgery to avoid joint stiffness.Cite this article: EFORT Open Rev 2019;4:1-9. DOI: 10.1302/2058-5241.4.180022.

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“…A dorsal and a varus angulation of the ulna is described in the proximal metaphysis. This leads to a complex anatomy with two joints for elbow and forearm motion and a wide individual variability [6][7][8].Especially the restoration of the proximal ulna dorsal angulation (PUDA) seems to have an impact on the functional outcome [9,10].…”

Section: Introductionmentioning

confidence: 99%

Computer tomographic analysis of anatomic characteristics of the ulna – essential parameters for preshaped implants

et al. 2020

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Anatomically preshaped implants are needed for exact restoration of the anatomy after fractures of the proximal ulna and ulnar shaft, which enables a good functional outcome. Aim of this computed tomographic analysis was to identify specific characteristics of the ulna. The data serve for the development of a new intramedullary implant for stabilisation of proximal and diaphyseal ulna fractures. Methods With a standardized research method 100 CT scans of the ulna were evaluated regarding anatomic parameters like width of the medullary canal, proximal ulna dorsal angulation and varus angulation. Also, correlations of these parameters were analyzed statistically. Results The mean proximal ulna dorsal angulation (PUDA) was 6.4˚(SD 2.8˚), while the mean varus angulation of the proximal ulna was 12.4˚(SD 3.3˚). The length of the ulna bone was 253.6 mm (SD 19.9 mm) on average. The average minimum diameter of the medullary canal was 4.2 mm (SD 1.1 mm) located at 141.3 mm (SD 19.7 mm) from the olecranon tip. There is a positive correlation between age and minimum diameter in our patient cohort (p< 0.001). Conclusion Our study described the anatomy of the proximal ulna and the ulna shaft with a reproducible research method in a representative patient cohort. The knowledge of the evaluated anatomic parameters can lead to an improvement of any implant design for the fixation of proximal and diaphyseal ulna fractures.

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Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)

Cited by 22 publications

References 28 publications

Intramedullary screw fixation for simple displaced olecranon fractures

Intramedullary screw fixation for simple displaced olecranon fractures

Fractures of the proximal ulna: current concepts in surgical management

Computer tomographic analysis of anatomic characteristics of the ulna – essential parameters for preshaped implants

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