Fracture of the Olecranon: A Problem of Management

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Fifty-two patients undergoing open reduction, internal fixation, or primary excsion for fracture of the olecranon are reviewed. Average age at time of fracture was 35.8 years: the most common modes of injury were falling, auto accidents, and altercations. Complications of fixation requiring reoperation occurred in 15% of cases. The Leinbach malleable screw was the fixation device used in 60% of the cases requiring reoperation. We feel that properly placed large intramedullary screws, Kirschner-wires, and 18-gauge figure-of-eight wires, or threaded Steinmann pins plus anatomic reduction, have led to satisfactory results.

Radiographic union delayed beyond 8 weeks occurred in 20.5% of cases: however, those with sufficient followup went on to spontaenous radiographic union. Ulnar nerve neuropraxia, which resolved spontaneously, was noted in 2%, and significant heterotopic ossification in the olecranon fossa, prohibiting full extension, occurred in 5%. Range of motion at followup did not differ significantly between those undergoing excision or open reduction internal fixation; however, no objective comparisons between the two groups regarding triceps strength or mediolateral stability were obtained.

We conlcude that immediate open reduction and internal fixation are indicated for all fractures where feasible; however, patients in which fixation was delayed for 7 days or more did well in this series.

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