Intramedullary locking compression nail for the treatment of an olecranon fracture.

OBJECTIVE

Reconstruction of the anatomy of the olecranon, while protecting the soft tissue, by an internal stabilization method that is stable under exertion.

INDICATIONS: All olecranon fractures.

CONTRAINDICATIONS: Very small (< 5 mm) proximal fragments at the point of nail entry. Bony avulsions of the triceps tendon.

SURGICAL TECHNIQUE: In the case of displaced olecranon fractures, exposure of the ulnar nerve, open reduction, fracture retention with reduction forceps, introduction of a 1.6 or 2.0 mm thick central guide wire into the medullary cavity in a slightly radial direction, overdrilling with a 3.5- or 4.5-mm cannulated drill bit, introduction of the nail to the aiming arm, and locking with 2.0-mm threaded wires. If the fracture pattern is transverse or slightly oblique, axial compression can be achieved by insertion of a compression screw into the nail. Fragments from the posterior margin or medial/lateral comminuted zones can be fixed more securely to the system via fiber cerclage wires around the threaded wires. After checking by X-ray, shortening of the threaded wires with the bolt cutters.

POSTOPERATIVE MANAGEMENT: Stable under exertion, splint-free postoperative management for 6 weeks, followed by full load bearing.

RESULTS

From May 1999 to December 2002, 80 olecranon fractures were treated using the XS nail. 73 patients (91.3%) were followed up after an average of 15 months. 49 (67.1%) had a multifragmentary or comminuted fracture, and 24 (32.9%) a simple transverse fracture. According to the Murphy Score, results were excellent in 47 cases (64.4%), good in 21 (28.8%), satisfactory in three (4.1%), and poor in two (2.7%).