Olecranon fractures in children and adolescents: Outcomes based on fracture fixation

Perkins, Crystal; Busch, Michael T.; Christino, Melissa A.; Axelrod, Jed R.; Devito, Dennis P.; Fabregas, Jorge; Flanagan, Jill C.; Murphy, Joshua; Olszewski, Dana; Schmitz, Michael L.; Schrader, Tim; Willimon, S. Clifton

doi:10.1302/1863-2548.12.180029

Cited by 11 publications

(27 citation statements)

References 12 publications

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“…Tension band wire and suture constructs involve open incisions, placement of parallel K-wires, and steel wires or sutures in a figure-of-8 tension band configuration to provide compression across the fracture site with the eccentric triceps function. 15,16 Although tension band fixation can provide articular compression and enable early elbow motion, painful implants and soft-tissue irritation have been reported in up to 88% of patients. 17 In our series, only 1 patient reported softtissue irritation from prominent instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Compression Screw Fixation for Pediatric Olecranon Fractures

Mun

Suresh

Hayashi

et al. 2022

Journal of Pediatric Orthopaedics

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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.

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Section: Discussionmentioning

confidence: 99%

Compression Screw Fixation for Pediatric Olecranon Fractures

Mun

Suresh

Hayashi

et al. 2022

Journal of Pediatric Orthopaedics

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“…12 There is limited literature on implant removal time for pediatric olecranon fractures. Perkins et al 5 removed osteosynthetic material from 71% of patients with a mean removal time of 6.1 months. However, their total followup time for the TBW group was 6.4 months, and they did not report the implant removal time of the remaining 5 (29%) patients.…”

Section: Discussionmentioning

confidence: 99%

“…Several surgical modalities have been described in the literature; including compression screws, tension band wiring (TBW), and tension band sutures (TBS). 5,6 TBW seems to be the widely accepted method because compression screws have the potential to damage the growth plate and are associated with loss of fixation, and TBS has been reported with increased failure rates in patients over 50 kg. 5,7,8 However, the main problem with TBW is the requirement for painful osteosynthetic material removal in up to 88% of patients.…”

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confidence: 99%

Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?

Onay

Çelen

Öncül

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Olecranon fractures are rare conditions in childhood. The aim of this study was to investigate the factors affecting the results in surgically treated pediatric and adolescent olecranon fractures. Methods: The orthopaedic trauma database of a large academic tertiary center was retrospectively searched for patients who had sustained an olecranon fracture and were treated surgically between 2005 and 2021. Data related to demographic features, additional fractures, and the presence of any disease were obtained from the patient files. Mayo elbow performance score and the Turkish-language version of the shortened version of the disabilities of arm, shoulder, and hand scale were the main functional outcome measurements. Results: The study included 37 elbows of 34 patients with an average age at the time of surgery of 10.9±3.1 years. The mean follow-up period was 78.2±48.0 months (range, 12 to 196 mo). The 1-year fracture rate of contralateral olecranon was 75% in osteogenesis imperfecta patients. Concomitant fractures were 7 proximal radius, 1 medial epicondyle, and 2 capitellum fractures. The surgical treatment methods were tension band wiring (TBW), open reduction and isolated K-wire fixation, closed reduction and percutaneous fixation (CR-PP), and open reduction-plate fixation. The mean implant removal time in patients treated with closed reduction and percutaneous fixation was 2.2 months, open reduction and isolated K-wire fixation 4.7 months, and TBW 12.7 months (P=0.004). The mean disabilities of arm, shoulder, and hand scale was 1.9. The mean Mayo elbow performance score was 100. Grade 1 elbow arthritis was determined in 3 patients. No patient underwent revision surgery. Conclusions: All treatment modalities provided excellent long-term functional results and low complication rates without the need for revision. Closed reduction-percutaneous fixation and open reduction-isolated K-wire fixation were associated with shorter implant removal times compared with TBW. Level of Evidence: Level III.

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“…Olecranon fractures are rare in children, representing approximately 5% of all elbow fractures [6]. Because these fractures involve the articular surface of the elbow joint and may affect the development of ulnar bone epiphyses, the standard indication for surgical reduction is generally considered to be a fracture displacement distance greater than 4 mm [13].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous classi cation systems have been described in the literature for olecranon fractures, but the most commonly used is the Mayo classi cation. Although various xation methods can be used for the treatment of displaced olecranon fractures, such as isolated pinning, percutaneous screw xation, cerclage with Kirschner wires, pinning with threaded pins with adjustable lock, and tension band wire (TBW) xation [1,5,6], there are no clear indications in the current literature regarding which surgical technique should be adopted for the treatment of Mayo type IIA olecranon fractures. The most commonly used surgical techniques for simple olecranon fractures are TBW and tension band suture (TBS) xation, which produce good outcomes with union occurring in nearly 90% of fractures with a single surgical procedure [3,7].…”

Section: Introductionmentioning

confidence: 99%

Short-term Outcomes of Herbert Screw Fixation for Isolated Olecranon Fractures in Children: a Single-institution Retrospective Study

Yang

Wang

Sun

et al. 2021

Preprint

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Background: Although various fixation methods can be used for the treatment of displaced olecranon fractures, there are no clear indications in the current literature regarding which surgical technique should be adopted. In this study, we evaluated the clinical and radiological outcomes of closed reduction with percutaneous Herbert screw fixation in children with isolated olecranon fractures.Methods: We retrospectively reviewed the records of children treated at our center for isolated olecranon fractures (Mayo type IIA) with closed reduction and percutaneous Herbert screw fixation between January 2016 and December 2018. Radiographic assessment of fracture healing was performed 6–8 months postoperatively and included assessment for loss of reduction and maximum length of the ulna. Clinical outcomes included elbow flexion and extension, forearm pronation and supination, short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, and complications. The Herbert screws were removed by a second operation.Results: A total of 14 patients with an average age at the time of injury of 11.36 (range, 10–14) years were included. All patients had good radiological and clinical outcomes at 6–8 months postoperatively; all had normal elbow ranges of motion and showed complete bone healing on radiographs. There were no cases of foreign body irritation, implant migration, or osteoarthritis. Premature epiphyseal closure was noted in six patients. The average QuickDASH score was 1.58. Conclusions: Fixation of olecranon fractures with Herbert screws is a safe and easy fixation method in young patients, leading to good functional and radiological results. Nonetheless, determination of the effects of this treatment method on the olecranon ossification center requires long-term follow-up.

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Olecranon fractures in children and adolescents: Outcomes based on fracture fixation

Cited by 11 publications

References 12 publications

Compression Screw Fixation for Pediatric Olecranon Fractures

Compression Screw Fixation for Pediatric Olecranon Fractures

Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?

Short-term Outcomes of Herbert Screw Fixation for Isolated Olecranon Fractures in Children: a Single-institution Retrospective Study

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