Comparison of Treatment Results of Simple Displaced Olecranon Fractures with AO Tension Band Wiring and Locked Anatomic Olecranon Plate

Year 2020, , 16 - 23, 31.08.2020

Birkan Kibar

https://doi.org/10.47493/abantmedj.2020.2

Abstract

INTRODUCTION: We aimed to compare the radiological and clinical results of simple displaced olecranon fractures, who underwent surgical treatment with AO tension band and locked anatomic olecranon plate.
METHODS: Between 2012 and 2017, 43 patients with olecranon fractures treated surgically with AO tension band and locked anatomic olecranon plate, included in the study and retrospectively examined. Only type 2A olecranon fractures according to Mayo classification were included in the study. There were 23 patients in tension band group (group 1), 20 patients in the plate group (group 2). The mean age of the patients in group 1 was 38.1 (14 male, 9 female), group 2 was 49 (13 male, 7 female).
RESULTS: Union was achieved in all patients in the study. The mean flexion-extension arc of group 1 was 130,87±12,58°, the mean flexion-extension arc of group 2 was 129±15,69°, the mean pronation- supination arc of group 1 was 176,17±3,86°, the mean pronation-supination arc of group 2 was 175,75±4,38°. The mean DASH score of group 1 was 9,44±9,66, the mean DASH score of group 2 was 10,19±12,31. The mean Mayo elbow performance score of group 1 was 85,87±12,58, the mean Mayo elbow performance score of group 2 was 86±11,77. There was no statistically significant difference between groups in terms of flexion-extension arc, pronation-supination arc, grip force, DASH and Mayo elbow performance score. From 9 patients (39.1%) in group 1, and 5 patients (25%) in group 2, fixation materials were removed at an average of 14 and 17 months after surgery due to implant irritation, respectively.
DISCUSSION and CONCLUSION: Tension band wiring and plate fixation are a good alternative to each other with similar clinical and radiological results and complication rates in simple displaced olecranon fractures.

Keywords

Olecranon, fracture, tension band, locked plate

Basit Deplase Olekranon Kırıklarının AO Gergi Bandı ve Kilitli Anatomik Olekranon Plağıyla Tedavi Sonuçlarının Karşılaştırılması

Abstract

GİRİŞ ve AMAÇ: Çalışmamızda, AO gergi bandı ve kilitli anatomik olekranon plağıyla cerrahi tedavi uygulanan basit deplase olekranon kırıklı hastaların, radyolojik ve fonksiyonel sonuçlarını geriye dönük olarak inceleyip, karşılaştırmayı amaçladık.
YÖNTEM ve GEREÇLER: 2012 ile 2017 yılları arasında olekranon kırığı nedeniyle, AO gergi bandı ve kilitli anatomik olekranon plağıyla cerrahi tedavi uygulanmış 43 hasta çalışmaya dahil edildi ve geriye dönük olarak incelendi. Çalışmaya sadece Mayo sınıflamasına göre tip 2A kırıklar dahil edildi. Gergi bandı grubunda (grup 1) 23 hasta, plak grubunda (grup 2) 20 hasta bulunmaktaydı. Grup 1’in yaş ortalaması 38.1 (14 erkek, 9 bayan), grup 2’nin yaş ortalaması 49 (13 erkek, 7 bayan) idi.
BULGULAR: Çalışmadaki tüm hastalarda kaynama elde edildi. Grup 1’in fleksiyon-ekstansiyon arkı ortalama 130,87±12,58°, Grup 2’nin fleksiyon-ekstansiyon arkı ortalama 129±15,69° idi. Grup 1’in pronasyon-supinasyon arkı ortalama 176,17±3,86°, grup 2’nin pronasyon- supinasyon arkı ortalama 175,75±4,38° idi. Grup 1’in DASH skoru ortalaması 9,44±9,66, grup 2’nin DASH skoru ortalaması 10,19±12,31 idi. Grup 1’in Mayo dirsek performans skoru ortalaması 85,87±12,58, grup 2’nin Mayo dirsek performans skoru ortalaması 86±11,77 idi ve gruplar arasında dirsek fleksiyon-ekstansiyon arkı, pronasyon-supinasyon arkı, DASH ve Mayo dirsek performans skorları, kavrama kuvveti ve komplikasyonlar açısından istatistiksel olarak anlamlı fark saptanmadı. Grup 1’de 9 (%39,1), grup 2’de 5 (%25) hastada implant irritasyonuna bağlı ameliyat sonrası sırasıyla ortalama 14. ve 17. aylarda tespit materyalleri çıkartılmıştır.
TARTIŞMA ve SONUÇ: Benzer klinik ve radyolojik sonuçlar, komplikasyon oranları ile basit deplase olekranon kırıklarında gergi bandı ve plak fiksasyonu birbirlerinin iyi birer alternatifidirler.

Keywords

Olekranon, kırık, gergi bandı, kilitli plak

References

• Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of fractures of the proximal ulna. Injury 2012; 43(3): 343-6.
• Closkey RF, Goode JR, Kirschenbaum D, Cody RP. The role of coronoid process in elbow stability. A biomechanical analysis of axial loading. J Bone Joint Surg Am 2000; 82(12): 1749-53.
• Amis AA, Miller JH. The mechanism of elbow fractures: an investigation using impact tests in vitro. Injury 1995; 26(3): 163-8.
• Baecher N, Edwards S. Olecranon fractures. J Hand Surg Am 2013; 38(3): 593-604.
• Wilkerson JA, Rosenwasser MP. Surgical techniques of olecranon fractures. J Hand Surg Am 2014; 39(8): 1606-14.
• Amini MH, Azar FM, Wilson BR, Smith RA, Mauck BM, Throckmorton TW. Comparison of outcomes and costs of tension band and locking plate osteosynthesis in transverse olecranon fractures: A matched-cohort study. Am J Orthop 2015; 44(7): 211-5.
• Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon and the coronoid. Instr Course Lect 1995; 44: 175-85.
• Hudak PL, Amedio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The upper extremity colloborative group. Am J Ind Med 1996; 29(6): 602-8.
• Cusick MC, Bonnaig NS, Azar FM, Mauck BM, Smith RA, Throckmorton TW. Acuuracy and reliability of the Mayo elbow performance score. J Hand Surg Am 2014; 39(6): 1146-50.
• Duckworth AD, Bugler KE, Clement ND, Court-Brown CM, Mcquenn MM. Nonoperative management of displaced olecranon fractures in low-demand elderly patients. J Bone Joint Surg Am 2014; 96(1): 67-72.
• Argintar E, Cohen M, Eglseder A, Edwards S. Clinical results of olecranon fractures treated with multiplanar locked intramedullary nailing. J Orthop Trauma 2013; 27(3): 140-4.
• Wilkerson JA, Rosenwasser MP. Surgical techniques of olecranon fractures. J Hand Surg Am 2014; 39(8): 1606-14.
• Erturer RE, Sever C, Sonmez MM, Ozcelik IB, Akman S, Ozturk I. Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. J Shoulder Elbow Surg 2011; 20(3): 449-54.
• Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stockle U, Lucke M. Comminuted fractures of the proximal ulna- Preliminary results with an anatomically preshaped compression plate (LCP) system. Injury 2010; 41(12): 1306-11.
• Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 2009; 91(10): 2416-20.
• Bailey CS, Macdermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma 2001; 15(8): 542-8.
• Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD. Is tension band wiring technique the ‘gold standart’ for the treatment of olecranon fractures? A long-term functional outcome study. J Orthop Surg Res 2008; 22: 3-9.
• Van der Linden SC, van Kampen A, Jaarsma RL. K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 2012; 21(3): 405–11.
• Romero JM, Miran A, Jensen CH. Complications and re-operation rate after tension-band wiring of olecranon fractures. J Orthop Sci 2000; 5(4): 318-20.
• Ikeda M, Fukushima Y, Kobayashi Y, Oka Y. Comminuted fractures of the olecranon. Management by bone graft from iliac crest and multiple tension-band wiring. J Bone Joint Surg Br 2001; 83(6): 805-8.
• Schliemann B, Raschke MJ, Groene P, Weimann A, Wahnert D, Lenschow S et al. Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo tip 2A olecranon fractures. Acta Orthop Belg 2014; 80(1): 106-11.
• Tarallo L, Mugnai R, Adani R, Capra F, Zambianchi F, Catani F. Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg 2014; 134(8): 1107-14.
• Wood T, Thomas K, Farrokhyar F, Ristevski B, Bhandari M, Petrisor B. A survey of currrent practices and preferences for internal fixation of displaced olecranon fractures. Can J Surg 2015; 58(4): 250-6.
• Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 1992; 285: 229-35.
• Macko D, Szabo RM. Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 1985; 67(9): 1396-401.