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Surgical treatment of displaced olecranon fractures in children
B C Gaddy1, W B Strecker, P L Schoenecker
1Department of Orthopedic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, Missouri, USA.
Insights
This study found that both minimally displaced (Type I) and significantly displaced (Type II) olecranon fractures in children can achieve satisfactory outcomes with appropriate treatment. Early surgical intervention for Type II fractures is crucial for optimal joint function.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Pediatric trauma
Background:
- Olecranon fractures are uncommon in children.
- Fracture displacement on initial radiographs may underestimate intra-articular involvement.
Purpose of the Study:
- To classify olecranon fractures in children based on displacement.
- To evaluate treatment outcomes for different fracture types.
- To emphasize the importance of accurate assessment for optimal joint function.
Main Methods:
- Retrospective review of 35 pediatric olecranon fractures.
- Classification into Type I (<3 mm displacement) and Type II (>=3 mm displacement).
- Treatment comparison: closed methods for Type I, open reduction internal fixation for Type II.
Main Results:
- All 23 Type I fractures treated non-operatively had satisfactory results.
- 10 of 12 Type II fractures treated operatively had satisfactory results.
- Intraoperative findings often revealed greater displacement than initial radiographs suggested.
Conclusions:
- Both conservative and surgical management can yield good outcomes for pediatric olecranon fractures.
- Accurate assessment of articular displacement is critical for treatment planning.
- Restoring the articular surface is key to preserving joint function and growth potential.
Abstract:
Thirty-five children who had fractures of the olecranon were reviewed. Age at the time of injury ranged from 0 years 2 months to 15 years 4 months. Fractures were retrospectively classified as type I or II according to the amount of displacement apparent on the initial radiographs. Type I fractures were those with < 3 mm of displacement, and type II were those with displacement of > or = 3 mm. Type I fractures (n = 23) were treated with closed methods, and splint or cast immobilization was maintained for an average of 3 weeks. All 23 type I fractures had satisfactory results on follow-up. Type II fractures (n = 12) were treated with open reduction and internal fixation. Greater intraarticular displacement was often seen intraoperatively than had been appreciated radiographically. Ten of 12 patients with type II fractures were available for follow-up; all had satisfactory results. Restoration of the articular surface in children with olecranon fractures optimizes joint function and growth potential. The amount of fracture may be more than is apparent on plain radiographs.