Simple or Compound Olecranon Fractures. Improved Stability and Functional Therapy Using a New Operative Technique

Abstract

Introduction: The open reduction and internal fixation of olecranon fractures places high demands on the fixation device regarding the osseous anchorage and soft-tissue damage. In tension-band wiring, implant loosening and failure of osteosynthesis are frequent complications following mobilization. One of the biomechanical reasons given for this is the eccentric position of the tension band. Plate osteosynthesis - reserved for the more complex types of fracture - does not always provide sufficient stability, particularly in the case of fractures associated with osteoporosis and additional medial, lateral, frontal and extremely small proximal fragments. Another problem is the subcutaneous position of the implant, which can increase soft-tissue complications. Materials and Methods: The IP-X(X)S(L) nail described here is a locking nail with the option of interfragmentary compression. It is locked by threaded K-wires and has been used for all olecranon fractures treated in our clinic since May 1999. From May 1999 until December 2002, 80 olecranon fractures were treated with the XS nail. After an average period of 15 months, 73 of these 80 (follow-up 91.3 %) patients were investigated. Included in this group were 49 (67.1 %) patients with comminuted fractures and 24 (32.9 %) patients with two-fragment fractures. Olecranon osteotomies were excluded. Results: There were six (8.2 %) cases of dislocation of the transverse locking wires, two requiring re-osteosynthesis which were without complications. Two (2.7 %) cases had to be revised because of irritation of nerve structures. No cases of acute or chronic osteitis, implant failure or non-union after primary XS-nail osteosynthesis were found. Using the Murphy score, 47 (64.4 %) excellent, 21 (28.8 %) good, 3 (4.1 %) satisfactory and 2 (2.7 %) poor results were obtained in this group. Conclusion: The IP-XS nail fulfills the requirements of minimal soft-tissue trauma and secure fixation in the treatment of all types of olecranon fractures.

Key words

olecranon fractures - IP-XS nail - locking nail - compression nail - stable osteosynthesis

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