Devising Osteosynthesis for the Reverse Oblique Olecranon Fracture: A Case Report
Eri Maeda1, Yoichi Sugiyama1, Mayuko Kinoshita1
1Department of Orthopaedics, Juntendo University School of Medicine, Tokyo, Japan.
Journal of Orthopaedic Case Reports
|March 28, 2019
Summary
Tension band wiring (TBW) alone is insufficient for reverse oblique olecranon fractures, often leading to redisplacement. Combining TBW with plate fixation offers a more stable solution for these challenging fractures.
Area of Science:
- Orthopedic surgery
- Traumatology
- Fracture fixation
Background:
- Reverse oblique olecranon fractures present challenges for standard osteosynthesis.
- Routine tension band wiring (TBW) can lead to fixation failure and redisplacement in these fracture patterns.
Observation:
- A 60-year-old male with a Colton type 2A olecranon fracture experienced hardware failure and displacement after initial TBW.
- Reoperation was necessary due to K-wire distortion and fragment displacement.
Findings:
- Modified TBW with K-wires acting as intramedullary nails improved compression.
- Adjunctive olecranon locking plate fixation provided enhanced stability for the distal fragment.
- At 12 months post-reoperation, the patient showed good functional outcomes (VAS 2/10, QuickDASH 2.27/100, Mayo Elbow score 85/100) and radiographic union.
Implications:
- The non-vertical fracture line in reverse oblique olecranon fractures compromises the compression achieved with standard TBW.
- Combined TBW and plate fixation is recommended for achieving stable osteosynthesis in reverse oblique olecranon fractures.
- This approach may prevent post-operative redisplacement and improve patient outcomes.
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