Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures.

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Abstract

[Indexed for MEDLINE] 15. J Hand Surg Am. 2015 Apr;40(4):711-5. doi: 10.1016/j.jhsa.2014.12.026. Epub 2015 Feb 18. Olecranon fractures with sagittal splits treated with dual fixation. Morwood MP(1), Ruch DS(2), Leversedge FJ(2), Mithani SK(2), Kamal RN(2), Richard MJ(2). Author information: (1)Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC. Electronic address: mpm34@duke.edu. (2)Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC. Comment in J Hand Surg Am. 2015 Sep;40(9):1920. doi: 10.1016/j.jhsa.2015.05.028. PURPOSE: To assess the results of olecranon fractures with an intra-articular sagittal plane fracture managed by orthogonal fixation constructs. METHODS: A retrospective chart review was performed and 14 proximal ulna fractures with intra-articular comminution resulting in separate medial and lateral fragments were identified. All fractures were classified according to the Schatzker, Mayo, and AO classification systems. Postoperative functional assessment, Disabilities of the Arm, Shoulder, and Hand (DASH) score, time to union, and complications were recorded. RESULTS: Eleven patients were treated with both dorsal and lateral plates. Three patients were managed with a single dorsal plate and cerclage wires. All fractures healed. Mean length of follow-up was 15 months (range, 4-72 mo). Mean range of motion at final follow-up was a flexion-extension arc of 24° to 129° with 89° and 79° of pronation and supination, respectively. The most common complication was symptomatic hardware, leading to removal of hardware in 5 of 14 (36%) patients. Average postoperative Disabilities of the Arm, Shoulder, and Hand score was 7. Two patients developed heterotopic ossification and 1 patient required a local pedicled flap for soft-tissue coverage. CONCLUSIONS: Identification of this subset of fractures is critical to successful management. A supplemental lateral plate or cerclage wires can successfully manage these difficult fractures and achieve good outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jhsa.2014.12.026