Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study

Nowak, T.; Burkhart, Klaus J.; Andres, Torsten; Dietz, Sven-Oliver; Klitscher, Daniela; Mueller, Lars P.; Rommens, Pol Maria

doi:10.1007/s00264-013-1854-0

Cited by 28 publications

(19 citation statements)

References 16 publications

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“…In the past decades several intramedullary implants were developed, mostly for the treatment of olecranon fractures or osteotomies [ 27 – 30 ]. Despite reports of good biomechanical and clinical results this technique is not established in clinical practice [ 7 , 9 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Intramedullary implants are available for fracture fixation of the proximal ulna and show promising biomechanical and clinical results, but are not used regularly in clinical practice [ 9 , 10 ]. These implants can theoretically reduce disadvantages and complications of plate osteosynthesis due to a less invasive approach and better biomechanical properties [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis

Hopf

Nowak

Mehler

et al. 2020

BMC Musculoskelet Disord

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Background Comminuted proximal ulna fractures are severe injuries with a high degree of instability. These injuries require surgical treatment, usually angular stable plating or double plating is performed. Nailing of proximal ulna fracture is described but not performed regularly. The aim of this study was to compare a newly developed, locked proximal ulna nail with an angular stable plate in an unstable fracture of the proximal ulna. We hypothesize, that locked nailing of the proximal ulna will provide non-inferior stability compared to locked plating. Methods A defect fracture distal to the coronoid was simulated in 20 sawbones. After nailing or plate osteosynthesis the constructs were tested in a servo-pneumatic testing machine under physiological joint motion (0°-90°) and cyclic loading (30 N – 300 N). Intercyclic osteotomy gap motion and plastic deformation of the constructs were analyzed using micromotion video-analysis. Results The locked nail showed lower osteotomy gap motion (0.50 ± 0.15 mm) compared to the angular stable plate (1.57 ± 0.37 mm, p < 0.001). At the anterior cortex the plastic deformation of the constructs was significantly lower for the locked nail (0.09 ± 0.17 mm vs. 0.39 ± 0.27 mm, p = 0.003). No statistically significant differences were observed at the posterior cortex for both parameters. Conclusions Nail osteosynthesis in comminuted proximal ulna fractures shows lower osteotomy gap motion and lower amount of plastic deformation compared to locking plate osteosynthesis under laboratory conditions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis

Hopf

Nowak

Mehler

et al. 2020

BMC Musculoskelet Disord

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“…When there is significant articular comminution, use of intramedullary nail would be limited Currently DePuy Synthes provide commercially available Intramedullary nailing systems for olecranon fractures. [24][25][26][27] …”

Section: ) Intramedullary Nailmentioning

confidence: 99%

Surgical Treatment of Olecranon Fractures

Koh

2017

Clinics in Shoulder and Elbow

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Since the olecranon fractures are caused by relatively low-energy injuries, such as a fall from standing height, they are usually found without comminution. Less commonly they can be developed by high-energy injuries and have severe concomitant comminution or injuries to surrounding structures of the elbow. Because the fracture by nature is intra-articular with the exception of some avulsion-type fracture, a majority of olecranon fractures are usually indicated for surgical treatment. Even if there is minimal displacement, surgical treatment is recommended because there is a possibility of further displacement by the traction force of triceps tendon. The most common type of olecranon fracture is displaced, simple non-comminuted fracture (that is, Mayo type IIA fractures). Although tension band wiring was the most widespread treatment method for these fractures previously, there is some trends toward fixation using locking plates. Primary goal of the surgery is to restore a congruent joint and extensor mechanisms by accurate reduction and stable fixation so that range of motion exercises can be performed. The literature has shown that good clinical outcomes are achieved irrespective of surgical fixation technique. However, since the soft tissue envelope around the elbow is poor and the implants are located at the subcutaneous layer, implant irritation is still the most common complication associated with surgical treatment.

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“…Numerous methods have been used for the fixation of the osteotomy such as tension band wiring (TBW), intramedullary screw with or without TBW, olecranon plate, and olecranon nail. 6,7 However, TBW remains the most popular choice even today owing to its ease of application and surgical familiarity. 8 Complications such as nonunion, loss of reduction, implant prominence, skin necrosis have all been well described in the literature.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Retrospective Analysis of Tension Band Wiring and 3.5 mm Precontoured Plate Used for Fixation of Chevron Osteotomy in Type C Distal Humerus Fractures

Nayak

Yadav

Batra

et al. 2020

International Journal of Recent Surgical and Medical Sciences

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Introduction Complex distal humerus fractures are rare and difficult to treat and traditionally requires an open reduction and internal fixation via a transolecranon approach. However, controversy remains regarding the better method of fixation of the chevron osteotomy. The purpose of the present study was to compare the clinical efficacy of tension band wiring (TBW) and 3.5 mm precontoured plate in treating the chevron osteotomy. Materials and Methods A consecutive series of 49 patients who required olecranon osteotomy for type C distal humerus fractures were identified and grouped according to the construct used. Clinic–radiological evaluation was done at 3 months, 6 months, 1 year, and 2 years. A total of 34 males and 15 females with a mean age of 36.9 ± 12.64 years (18–62 years) were included in the study. Surgical duration, range of motion, Mayo elbow performance score (MEPS), and complications were noted at the follow-up Results The mean range of motion was initially lower in the plate group (105 degrees ± 9.9 in plate, 107 degrees ± 9.15 in TBW) that subsequently increased at 6 months. The forearm rotation was similar in both the groups. The mean MEPS was found to be higher in the plate group at 2 years (81.83 ± 5.85 in plate, 77.76 ± 8.02 in TBW). A significantly higher rate of complications, that is, nonunion (p = 0.03), loss of reduction (p = 0.03), and revision (p = 0.04) was observed in the TBW group. However, other complications such as symptomatic hardware, wound complication, and removal of hardware were found to be higher in the plate group. Conclusion Both TBW and 3.5 mm precontoured plate provide comparable functional outcomes; however, the complication rate in terms of nonunion, loss of reduction, and revision is seen in the TBW, whereas wound complication and symptomatic hardware are more commonly seen in the plate.

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Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study

Cited by 28 publications

References 16 publications

Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis

Nailing vs. plating in comminuted proximal ulna fractures – a biomechanical analysis

Surgical Treatment of Olecranon Fractures

A Comparative Retrospective Analysis of Tension Band Wiring and 3.5 mm Precontoured Plate Used for Fixation of Chevron Osteotomy in Type C Distal Humerus Fractures

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