Olecranon fractures are uncommon in children, although the treatment remains controversial. Damage to the olecranon growth plate, either from the fracture or fixation, can result in an impaired ulnar growth and a limb length discrepancy. Displaced fractures should be treated with sufficiently stable fixation, while minimally invasive to preserve the remaining olecranon blood supply. Current recommendations include tension band fixation, Kirschner wire or lag screw fixation. Screw fixation is generally avoided to prevent damage to the growth plate. This report details a fixation technique using threaded pins with an adjustable lock. Six children were included in the small cohort. Follow-up averaged 6 months. Fractures were either nondisplaced or minimally displaced prior to fixation. A closed reduction was performed and placement of the threaded pins with an adjustable lock. A small skin incision (10mm) was necessary for introduction of the pins. The pins were placed to penetrate the anterior cortex. Subsequently, the adjustable lock threads a small ball through the skin and onto the bone (similar to a Jurgen ball). A cast is applied for 3-4 weeks and the pins removed between 6-8 weeks. Satisfactory reduction was obtained in five out of six cases, and no secondary displacement was noted. Five of the six children had an excellent outcome and one good. No complications were attributed to the internal fixation device.
This study introduces a new technique for olecranon fracture fixation in children. Previously, the authors have reported twenty-six patients with insufficient reduction in 47%. The enhanced reduction in this series is attributed to a better closed reduction, rather then the chosen internal fixation device. Union was uniform, although it is too early to conclude that growth arrest did not ensue. Elective removal of the pins prevented long-term sequelae attributed to prominent hardware.
J Ped Orthop