Journal of orthopaedic trauma · 2015
Treatment of olecranon fractures with 2.4- and 2.7-mm plating techniques.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Wellman David S, Lazaro Lionel E, Cymerman Rachel M, Axelrad Thomas W, Leu David, Helfet David L, Lorich Dean G
Аннотация
OBJECTIVES: To evaluate the outcomes of olecranon fractures treated with 2.4- and 2.7-mm plate constructs.
DESIGN: Retrospective Case Series.
SETTING: One-level 1 trauma center and 1 tertiary care hospital.
PATIENTS: Thirty-five consecutive patients meeting inclusion criteria.
INTERVENTION: A 2.7- or 2.4-mm reconstruction plate was placed on the dorsal ulnar cortex and contoured to allow passage of either a 2.7- or 3.5-mm intramedullary screw. In 9 patients, additional plates were required to control comminution. Available computed tomographic (CT) scans were evaluated for the presence of comminution.
MAIN OUTCOME MEASUREMENTS: Average Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo Elbow Performance Score (MEPS).
RESULTS: All fractures were united. Average extension deficit was 4.2 degrees, and average flexion angle was 137.4 degrees. Outcome scores were completed by 94% (33/35) of study patients. Average DASH score was 6.6, and average MEPS score was 94.5. Implants were removed in 18 patients. In the cohort of patients with CT scans, 6 of the 7 fractures thought to be simple on plain film analysis were found to have occult comminution on CT scan.
CONCLUSIONS: Comminution should be considered in all olecranon fractures, even when plain films display simple patterns; although this did not affect treatment in this series of plated patients, it may be important if selecting tension band wiring. Fixation with 2.4- and 2.7-mm plates addresses comminution in olecranon fractures, avoiding the pitfalls of tension band wiring. In patients with completed outcome scores, 97% (32/33) reported their outcomes as good or excellent according to the MEPS.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective Case Series.
SETTING: One-level 1 trauma center and 1 tertiary care hospital.
PATIENTS: Thirty-five consecutive patients meeting inclusion criteria.
INTERVENTION: A 2.7- or 2.4-mm reconstruction plate was placed on the dorsal ulnar cortex and contoured to allow passage of either a 2.7- or 3.5-mm intramedullary screw. In 9 patients, additional plates were required to control comminution. Available computed tomographic (CT) scans were evaluated for the presence of comminution.
MAIN OUTCOME MEASUREMENTS: Average Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo Elbow Performance Score (MEPS).
RESULTS: All fractures were united. Average extension deficit was 4.2 degrees, and average flexion angle was 137.4 degrees. Outcome scores were completed by 94% (33/35) of study patients. Average DASH score was 6.6, and average MEPS score was 94.5. Implants were removed in 18 patients. In the cohort of patients with CT scans, 6 of the 7 fractures thought to be simple on plain film analysis were found to have occult comminution on CT scan.
CONCLUSIONS: Comminution should be considered in all olecranon fractures, even when plain films display simple patterns; although this did not affect treatment in this series of plated patients, it may be important if selecting tension band wiring. Fixation with 2.4- and 2.7-mm plates addresses comminution in olecranon fractures, avoiding the pitfalls of tension band wiring. In patients with completed outcome scores, 97% (32/33) reported their outcomes as good or excellent according to the MEPS.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.