This is a retrospective review article of 37 consecutively treated olecranon fractures. The surgical procedure involved the standard use of 2 Kirschner wires and a single figure-of-eight tension wire. Follow-up was performed at a mean of 4 years using the Mayo Elbow Performance Score as well as the DASH score. Results indicate that 33 of 37 patients had mild or no pain. The mean loss of extension was 7 degrees with a range of 0-25, and the mean elbow flexion was 131 degrees with a range of 95-140. Results were graded as good or excellent in 86% of cases. Those with degenerative changes and elbow instability did more poorly. Hardware removal was required in 17 or 46% of cases.
The study is somewhat flawed in that it includes a heterogeneous group of injuries: 5 were trans-olecranon dislocations and 3 had an associated radial head fracture. In addition, 5 patients had extension of the fracture into the coronoid process. However, it does demonstrate the difficulty treating these injuries, and not all “olecranon” fractures are equal. The simple avulsion due to the triceps is an entirely different entity than the impaction fracture (e.g. transolecranon fracture-dislocation) that can involve severe cartilage trauma, ligamentous disruption, coronoid process injury with elbow instability, etc. The Monteggia equivalent not uncommonly involves fracture of the radial head. In this series, there was a high association of degenerative changes and worse outcomes at follow-up in patients with radial head or coronoid fractures and dislocations. The study also demonstrates a 46% hardware removal rate. Unfortunately, there is very little soft-tissue covering the proximal ulna and hardware removal is not uncommon whatever the chosen method of internal fixation.
Journal of Shoulder and Elbow Surgery