MANAGEMENT OF COMMINUTED FRACTURES OF THE OLECRANON BY TENSION BAND WIRING
AbstractBackground: Open reduction and rigid internal fixation has become the generally accepted method of treatment for displaced fractures of the olecranon in order to allow early mobilisation and to prevent contracture of the elbow. Comminuted fractures of olecranon are unstable, therefore, bone graft and tension band wiring are supposed to give good stability. Here we give an account of our experience with this procedure. Methods: We treated ten patients with comminuted fractures of the olecranon by multiple tension-band wiring and a graft from the iliac crest between 1999 and 2002 at Ayub Teaching Hospital, Abbottabad. After initial immobilization strengthening and endurance exercises were started. The patients were followed up for stability, muscle strength, active range of flexion and extension at elbow and rotation of forearm. Results: The time to union of the fractures was 3 to 7 months. No patient reported difficulties with activities of daily living or symptoms of instability of the elbow. The median flexion was up to 135° (125° to 145°) with a median flexion contracture of 15° (range10° to 30°). The median pronation was 70° (60° to 80°) and median supination 79° (70° to 90°). Only three patients had mild pain and loss of strength. Five patients had excellent and 5 good results with a median Broberg and Morrey index score of 94.5 points (84 to 100). Conclusion: Our results are in accordance with those reported from other centres and the technique is thought to be a practical alternative to plate fixation of olecranon fractures with extreme comminution.Keywords: Olecranon; comminuted fracture; tension band wiring
Colton CL. Fractures of the olecranon in adults: classification and management. Injury 1973;5:121-9.
Wolfgang G, Burke F, Bush D. Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop 1987;(224):192-204.
Murphy DF, Greene WB, Dameron TB. Displaced olecranon fractures Clin Orthop 1987;224:192-204
Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, Eds. Rockwood and Green’s fractures in adults. Vol. 1, 4th ed. Philadelphia: Lippincott-Raven, 1996: pp 929-1024.
Cababela ME, Morrey BF. Fractures of the olecranon in: Morrey BF, Ed. The elbow and its disorders. Third ed. Philadelphia,; WB Saunders Company, 2000: pp 365-7.
Teasdall R, Sovoie FH, Hughes J. Comminuted fractures of the proximal radius and ulna. Clin Orthop 1993;292:37-47.
Morrey BF. Current Concepts in treatment of fractures of the radial head, the olecranon and the coronoid. J Bone Joint Surg Am 1995;77-A:316-27.
King GJW, Lammens PN, Milne AD, Roth JH, Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. J Shoulder Elbow Surg 1996;5:437-41.
Sipmson NS, Goodman LA, Jupiter JB. Contoured LCDC Plating of the proximal ulna. Injury 1996;27:411-7.
Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Trans olecranon fracture dislocation of the elbow. J Orthop Transuma 1997;11:525-50.
Ikeda, M, Fukushima Y, Kobayashi Y, Oka Y, Comminuted fractures of olecranon; management by bone graft from the iliac crest and Multiple tension band wiring. J Bone Joint Surgery Br 2001;83(6):805-8.
Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Joint Surg Am 1976;58-A:453-8.
Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg Am 1986;68:669-74.
Prayson MJ, Williams JL, Marshall MP, Scilaris TA, Lingenfelter EJ. Biomechanical comparison of fixation methods in transverse olecranon fractures: a cadaveric study. J Orthop Trauma 1997;11:565-72.
Murphy DF, Greene WB, Gilbert JA, Dameron T. Displaced olecranon fractures in adults: biomechanical analysis of fixation methods. Clin Orthop 1987;224:210-4.
Fife IS, Mossad MM, Holdsworth BJ. Methods of fixation of olecranon fractures: an experimental study. J Bone Joint Surg Br 1985;67:367-72.
Weseley MS, Barenfeld PA, Eisenstenin AL. The use of the Zuelzerhook plate in fixation of olecranon fractures. J Bone Joint Surg Am 1976;58:859-63.
Hume MC, Wiss DA. Olecranon fractures: a clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orhtop 1992;285:229-35.
Estourgie RJA, Tinnemans JGM. Treatment of grossly comminuted fractures of the olecranon by excision. Neth J Surg 1982;34:127-9.