Outcomes and challenges in the surgical treatment of trans-olecranon fracture-dislocations: A case series study

Transolecranon fracture-dislocations represent a complex subset of elbow injuries characterized by concomitant fractures of the olecranon, coronoid process, and radial head, often associated with posterior dislocation. These injuries pose significant surgical challenges due to their inherent instability and high risk of poor functional outcomes. Despite previous studies describing different fixation techniques, there is no standardized surgical protocol to optimize outcomes. This study aims to evaluate the clinical and functional results of a structured surgical approach in the management of these injuries.

A retrospective case series was conducted, analyzing 12 patients with transolecranon fracture-dislocations treated at two orthopedic centers. Patients underwent open reduction and internal fixation (ORIF) using a standardized fixation sequence through the Wrightington posterolateral approach, with selective use of the anteromedial approach when necessary. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the Oxford Elbow Score (OES) at 2, 6, 12, and 24 months postoperatively. Radiographic follow-up included evaluation of bone healing, joint congruence, and post-traumatic arthritis. Statistical analysis was performed using repeated-measures ANOVA to assess functional improvement over time.

At a mean follow-up of 24 months, significant improvement in functional scores was observed. MEPS increased from 63 at two months to 90 at 24 months, while DASH scores decreased from 45 to 15, and OES improved from 28 to 46 over the same period. Range of motion showed progressive recovery, with mean flexion-extension reaching 160° of flexion and full extension at final follow-up. All fractures achieved radiographic consolidation, with no cases of implant failure. Despite evident clinical improvement, statistical significance was not achieved in ANOVA analysis (p > 0.05), likely due to sample size limitations.

A standardized surgical approach combining structured fixation strategies and early rehabilitation provides favorable clinical and functional outcomes in transolecranon fracture-dislocations. The results of this study reinforce the importance of anatomical reduction and stable fixation in restoring elbow function. Future studies with larger sample sizes are needed to further validate these findings and refine treatment protocols.

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