Abstract
Introduction: Olecranon fractures comprise 4–7% of all fractures around the elbow in the pediatric age group. 80% of these fractures can be treated expectantly. Fractures with 2 mm of displacement or more require surgical intervention. The surgical procedure commonly used is ORIF with 2 Kirschner wires and tension band wire as advocated by the AO technique. All open interventions require removal of hardware under anesthesia. We present our experience of five cases treated with percutaneously placed K-wires and absorbable sutures.
Patients and Methods: Five patients, 4 boys and one girl, average age 6 8/12 years (range 4½-14¼ years) with displaced fractures of the olecranon were treated with ORIF during the years 2000–2004. In two cases additional injuries were noted [a displaced lateral condyle fracture in one and a dislocated radial head (Monteggia variant) in another patient].
Under general anesthesia, the olecranon is approached through a posterior incision. After reduction, fixation is achieved with two K-wires, which are inserted percutaneously. Additional fixation is obtained with a heavy absorbable suture (Dexon, PDS) which is fashioned in a figure of eight around the protruding pins and through a hole in the proximal ulna. Stability is checked under vision before wound closure. K-wires are trimmed and a plaster cast is fitted with the elbow in flexion. The plaster cast and K-wires are removed 4 weeks post surgery after X-rays confirm that the fracture is healed and range of motion is started.
Results: Five patients have been treated with our technique; all fractures were reduced and stable in flexion and extension under vision at the end of surgery.
K-wires were removed 4 weeks postoperatively and patients were allowed free range of motion. No immediate complications were noted, none became infected and no loss of fixation was observed.
Conclusions: Anatomic reduction and stable fixation can be achieved by the surgical technique presented. The usual complication of hardware irritation and the need for additional surgery to remove K-wires and the metal TBW are avoided by the use of absorbable sutures and protruding K-wires. Functional outcome is excellent on short term follow-up. Larger numbers and prospective follow-up will tell whether this technique can replace the commonly used methods of olecranon fracture fixation in the pediatric age group.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
