Olecranon Osteotomy Fixation Using a Novel Device

Iorio, Timothy; Wong, Justin C.; Patterson, John M.; Rekant, Mark S.

doi:10.1097/bth.0b013e318298b39d

Cited by 11 publications

(13 citation statements)

References 12 publications

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“…This fact of the anatomy of the ulna contributes to the screw clamping screw in both fragments at the end of the surgery. The V-shaped Chevron olecranon osteotomy increases the stability of the fixation over the horizontal osteotomy, as well as increasing bone contact surface between the fragments, favouring their consolidation [10,17,19,21].…”

Section: Discussionmentioning

confidence: 99%

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Fixation of olecranon osteotomy only with 6′5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures

et al. 2021

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Purpose The objective of this study is to demonstrate the safety and efficacy of the osteosynthesis with a 6.5 mm screw and washer of a Chevron shape olecranon osteotomy performed for the surgical approach of supraintercondylar fractures of the distal humerus, achieving union and complication rates better or similar to other published case series. Methods From 2009 to 2019, 26 patients underwent fixation of an olecranon osteotomy for the treatment of a supraintercondylar fracture of the distal humerus with partially threaded cancellous cannulated screws of 6.5 mm diameter with a washer. The patients were followed for at least 1 year, taking radiographs the day after the surgery, at 3, 6 and 12 months. Complications have been collected: infection, loss of reduction, non-union, delay of union, discomfort of the osteosynthesis hardware. The diameter of the ulna medullary canal diaphysis was also measured in all patients. Results Consolidation of the osteotomy was 100% at 12 months. The average time of radiological consolidation was 112 ± 12 days. The average size of the ulna medullary canal diaphysis was 6′06 ± 0′16 mm on anteroposterior radiographs and 5′65 ± 0′14 mm on lateral radiographs. The mean screw length was 102′31 mm ± 3′89. We found 1 acute infection, 2 osteotomies delays of union (one of these cases was the acute infection case), one early osteosynthesis failure and 1 wound dehiscence. Conclusions Olecranon ostetomy fixation with a 6′5 mm cancelous partial threaded screw and washer is safe and effective with a high consolidation rate and excellent results and with complication rates similar to or lower than other fixation methods published. Long enough screws must be used to get a good cortical grip with enough stability. Level of evidence Level IV, Case series, retrospective review.

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Section: Discussionmentioning

confidence: 99%

“…In 2015 Wagener [19] used intramedullary cancellous screw and suture tension band with very good results in 19 patients. Iorio uses a novel device (the olecranon sled), obtains excellent rates of union [10].…”

Section: Introductionmentioning

confidence: 99%

Fixation of olecranon osteotomy only with 6′5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures

et al. 2021

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“…Clinically, there are limited reports on the use of the Olecranon Sled in the literature. 9,13 Iorio et al 9 reported their use of olecranon osteotomies repaired with the Olecranon Sled. Of 14 patients, 1 (7.1%) had symptomatic hardware requiring removal; this is far below tension band construct rates.…”

Section: Discussionmentioning

confidence: 99%

“…5 Limited clinical data are available on the use of the Olecranon Sled. 9,13 Iorio et al 9 reported on 14 patients, with 1 requiring hardware removal. In a larger case series, Lovy et al 13 found no instances of nonunion, malunion, or hardware removal.…”

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confidence: 99%

Biomechanical Comparison of Olecranon Sled Versus Intramedullary Screw Tension Banding for Olecranon Osteotomies

Kia

Dukas

Marshall

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Olecranon osteotomies are frequently performed to gain access to the distal humeral articular surface. Repair of the osteotomy or fixation of a simple 2-part olecranon fracture with traditional tension band construct is often plagued by complication. Proximal migration and irritation attributed to hardware are common complications of the standard construct of an intramedullary screw with tension band and are causes for reoperation.Purpose:To compare the biomechanical performance, time of implant, and prominence of an intramedullary screw and tension band construct with that of a newer low-profile continuous loop tension band (Olecranon Sled) construct in an olecranon osteotomy model.Study Design:Controlled laboratory study.Methods:Chevron osteotomies were created in 6 matched pairs of fresh-frozen human elbows (mean age, 66 ± 16 years). Each matched pair was then randomly divided into 1 of 2 groups: fixation with a screw and tension band construct or the Olecranon Sled. Bone mineral density, implant prominence, and time for implantation were recorded. Following olecranon fixation, each specimen underwent cyclic loading of 0 to 10 N for 100 cycles (to simulate unresisted active range of motion) and then 0 to 500 N for 500 cycles (to simulate pushing up from a chair) to measure for any displacement at the osteotomy site. The constructs were then loaded to failure and compared.Results:No differences were found in bone mineral density between the 2 groups (P = .290). When measured from the tip of the olecranon, the continuous loop tension band had a medial prominence of only 3.57 ± 0.4 mm, as opposed to the intramedullary screw fixation of 7.288 ± 0.762 mm (P = .027). Total time of implantation, including osteotomy preparation, was a mean 155 seconds shorter with the Olecranon Sled versus the traditional tension band (P < .05). Because of the fracture of 1 specimen during cyclic loading, it and its matched counterpart were excluded, and only 5 matched pairs were analyzed for displacement and load to failure. There were no significant differences between groups in load to failure or displacement during cyclic loading (P > .05).Conclusion:The Olecranon Sled device was found to have no difference in biomechanical strength from that of the standard intramedullary screw with tension band construct. The Olecranon Sled was also found to be significantly less prominent while being faster to implant than the intramedullary screw.Clinical Relevance:Evaluating an alternative option to the standard tension band construct is important for patients with olecranon fractures or osteotomies, as standard techniques have been fraught with hardware issues and need for revision surgery.

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“…In this case, the metacarpal sled simulates a tension band construct where the outer portion of the plate is located on the tension side of the fracture so that normal flexion forces across the metacarpal compresses the fracture. Similar sled constructs have been commercially available for fixation of medial malleolus ankle fracture and olecranon fracture [6,15].…”

Section: Discussionmentioning

confidence: 99%

Fixation for Metacarpal Neck Fracture: A Biomechanical Study

Malasitt

Owen

Tremblay

et al. 2015

Hand (New York, N,Y.)

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Background There is no robust evidence of the best operative treatment for displaced unstable metacarpal neck fractures. Numerous constructs are used in the fixation of metacarpal neck fractures. Currently, two common methods are dorsal locking plate and K-wire fixation. A new metacarpal sled fixation system for metacarpal neck fracture was designed to provide fracture stability but limit dissection and avoid exposed hardware. The purpose of this study was to compare the biomechanical integrity of the metacarpal sled versus standard locking plate fixation and retrograde K-wire fixation in a simulated porcine metacarpal fracture model. Methods Transverse metacarpal neck fractures were created in 30 porcine second metacarpals. The specimens were randomly fixed with locking plates, metacarpal sleds, or retrograde K-wires. Constructs were then loaded to failure in threepoint bending. Stiffness and peak load were measured from the load-to-failure deflection curve. Data were analyzed via ANOVA, followed by Tukey-Kramer's post hoc pairwise comparison. Results The K-wire group had the highest initial stiffness followed by the sled group and then the plate group. Statistical difference was only found between K-wires and plate. Peak load for the K-wire group was lowest, followed by sled, and then by plate. A statistically significant difference was observed between the peak loads of the K-wires and plate, as well as the sled and plate. However, a difference in peak load was not detected between the K-wires and sled.Conclusions For transverse metacarpal neck fractures, a metacarpal sled construct provides similar fixation to K-wires with limited dissection and without exposed hardware or the potential for soft tissue tethering. The new low profile construct using a minimally invasive technique would be suitable for unstable metacarpal neck fractures.

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Olecranon Osteotomy Fixation Using a Novel Device

Cited by 11 publications

References 12 publications

Fixation of olecranon osteotomy only with 6′5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures

Fixation of olecranon osteotomy only with 6′5 mm partially trheaded cancellous screw is a safe an effective method used in surgical management of distal humerus fractures

Biomechanical Comparison of Olecranon Sled Versus Intramedullary Screw Tension Banding for Olecranon Osteotomies

Fixation for Metacarpal Neck Fracture: A Biomechanical Study

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