What Is the Ideal Starting Point for an Olecranon Screw? An Anatomic Cadaveric Study

Gd, Potter; Mascarenhas, Daniel; Mf, Sciadini; Ar, Carlini; Rv, O'Toole; Ra, Pensy

doi:10.1097/bot.0000000000001139

Cited by 9 publications

(13 citation statements)

References 13 publications

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“…We believe this is because the varus curvature of the proximal ulna begins at approximately 8.2 cm from the olecranon tip and the anterior angulation starts at approximately 8.6 cm, while the inserted screws were only between 9 and 10 cm [28]. These anatomic characteristics highlight the importance of the central-central insertion point in facilitating the optimal direction of the screw [23].…”

Section: Discussionmentioning

confidence: 88%

“…A small longitudinal incision is made at the triceps insertion over the centre-centre point of the palpable olecranon tip to facilitate placement of an intramedullary 2.8 mm guide wire ( Fig. 2c, d) [23]. Screw length is then measured such that the distal threaded end of the screw will engage the narrow marrow of the proximal ulnar diaphysis (typically 90-110 mm) to provide stable fixation.…”

Section: Surgical Techniquementioning

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: 88%

Section: Surgical Techniquementioning

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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“…A central or laterally starting point was associated with better fracture reduction, probably associated with varus angulation. 29 From a biomechanical point of view, braided sutures have been tested in vitro and in vivo, where they have been shown to match the tensile strength and fatigue properties of stainless steel wires. 6,39 In addition, there are several cohorts and series of cases in which the fixation of olecranon fractures is performed with anchors and suture material or only with sutures, obtaining good clinical results without loss of reduction; thus, the use of sutures in this region meets the biomechanical requirements to achieve adequate stability of the fracture site.…”

Section: Discussionmentioning

confidence: 99%

Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up

Fernández

Beltrán

Cordova

et al. 2021

JSES Reviews, Reports, and Techniques

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Background: Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. Methods: We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Results: Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5 ± 14.8 (range, 70 -140 ) and the mean extension was À5.9 ± 7.0 (range, À20 -0 ). Mean pronation and supination were 85.8 ± 11.9 (range, 45 -90 ) and 86.9 ± 14.3 (range, 20 -90 ), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P ¼ 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P ¼ 0.05), articular angle (22.5 vs. 27.7 , P ¼ 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P ¼ 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7 vs. 6.4 , P ¼ 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P ¼ 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P ¼ 0.0219). Conclusion:The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.

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“…These constructs frequently require removal. 5 As an alternative, the olecranon may be fixed with a long (100-150 mm) intramedullary lag screw passed through a washer such that the washer engages the olecranon at the triceps insertion and the threads of the screw engage the diaphyseal medullary canal 6 (Fig. 2).…”

Section: Introductionmentioning

confidence: 99%