Mayo classification of olecranon fractures revisited - Assessment of intra- and interobserver reliability based on CT scans.

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Abstract

Conflict of interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 9. J Shoulder Elbow Surg. 2024 May;33(5):1084-1091. doi: 10.1016/j.jse.2023.12.021. Epub 2024 Feb 15. A novel fragment specific classification of complex olecranon fractures: 3-dimensional model design, radiological validation, and proposed surgical algorithm. Chapleau J(1), Joly-Chevrier M(2), Tohmé P(1), El-Kayem E(1), Petit Y(3), Rouleau DM(4). Author information: (1)Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. (2)Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. (3)Research Center, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada. (4)Department of Orthopedic Surgery, CIUSSS du Nord-de-l'île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada. Electronic address: dominique.rouleau@umontreal.ca. BACKGROUND: Current classifications for proximal ulna fracture patterns rely on qualitative data and cannot inform surgical planning. We propose a new classification system based on a biological and anatomical stress analysis. Our hypothesis is that fragment types in complex fractures can be predicted by the tendon and ligament attachments on the proximal ulna. METHODS: First, we completed a literature review to identify quantitative data on proximal ulna soft tissue attachments. On this basis, we created a 3-dimensional model of ulnar anatomy with SliceOMatic and Catia V5R20 software and determined likely locations for fragments and fracture lines. The second part of the study was a retrospective radiological study. A level-1 trauma radiological database was used to identify computed tomography scans of multifragmentary olecranon fractures from 2009 to 2021. These were reviewed and classified according to the "fragment specific" classification and compared to the Mayo and the Schatzker classifications. RESULTS: Twelve articles (134 elbows) met the inclusion criteria and 7 potential fracture fragments were identified. The radiological study included 67 preoperative computed tomography scans (mean 55 years). The fragments identified were the following: posterior (40%), intermediate (42%), tricipital (100%), supinator crest (25%), coronoid (18%), sublime tubercle (12%), and anteromedial facet (18%). Eighteen cases (27%) were classified as Schatzker D (comminutive) and 21 (31%) Mayo 2B (stable comminutive). Inter-rater correlation coefficient was 0.71 among 3 observers. CONCLUSION: This proposed classification system is anatomically based and considers the deforming forces from ligaments and tendons. Having a more comprehensive understanding of complex proximal ulna fractures would lead to more accurate fracture evaluation and surgical planning. Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jse.2023.12.021