Clinical Analysis Of Olecranon Fracture Associated With Posterior Dislocation Of Elbow

Objective:To investigate the clinical characteristics and the effect of surgical therapy for the olecranon fracture associated with posterior dislocation of the elbow.Method:Between January 2014 and January 2017,34 patients of the olecranon fracture associated with posterior dislocation of the elbow operated by open reduction and internal fixation in the Department of orthopedic trauma of Shangdong Provincial Hospital Affiliated to Shangdong,including 19 males and 15 females,aged 21-59 years old,with an average of age 35 years old,21 cases were in right and 13 in left.Among them,olecranon fracture:2 cases of oblique fracture,5 cases of transverse fracture,27 cases of comminuted fracture;Ulna coronoid fracture(34 cases)(Regan-Morrey classification):9 cases of type 11,25 cases of type Ⅲ;Radial head fracture(28 cases)(Mason classification):3 cases of type 1,13 cases of type Ⅱ,12 cases of typeⅢ.There were 6 cases of open fractures,4 cases of humeral shaft fractures,5 cases of pelvic fractures,and 3 cases of tibia and fibula fractures.X-ray and CT-3D of elbow joint were performed before operation.Operative approach:posterior median approach in 25 cases,posterior median approach combined with anterior approach in 9 cases.The ulnar olecranon fractures were treated with osteosynthesis in 28 cases,Kirschner wire tension band fixation in 6 cases,ulna coronoid fracture treatment:screw fixation in 27 cases,plate fixation in 5 cases,Kirschner wire fixation in 2 cases,radial head fracture treatment:screw fixation in 15 cases,plate fixation in 13 cases;After operation,there were 12 cases of plaster fixation,9 cases with hinge frame assisted external fixation.The elbow joint of 13 cases without external fixation was fixed at 90 degree elbow flexion,the elbow joint activity was guided in the early stage,and the follow-up was regularly followed.Results:All patients were followed up for 6-24 months,with an average of 12 months.After the operation,the functional evaluation was performed using the Mayo elbow function index score.The postoperative Mayo score was 86±5.2 points,of which 15 cases were excellent,13 cases were good,3 cases were good,3 cases were poor,and the good rate was 82%.The excellent rate after olecranon fracture with plate was 85.7%,and the excellent rate after olecranon fracture with the Kirschner tension band fixation was 66.7%,treatment of olecranon fracture with plate fixation is better.The excellent rate of the hinges assisted external fixation was 88.9%,the excellent rate of the plaster fixation was 75%,and the hinge shelf assisted external fixation is better than the plaster fixation for the improvement of the elbow joint function.The X-ray and CT reconstruction of the elbow joint were reexamined.All patients were satisfied with the reduction of ulnar olecranon,ulnar coronoid and radial head fracture.The curvature of the incisurae semilunaris was satisfactory.All fractures healed and the healing time was 2～5 months,with an average of 2.8 months.Postoperative complications:8 cases of different degrees of heterotopic ossification occurred after operation,of which 3 cases were severely affected by the elbow joint movement again with elbow joint release,and postoperative follow-up function recovered well;5 cases of osteoarthritis were treated with conservative treatment;1 case of internal fixation loosening were given conservative treatment,and 2 cases of wound infection occurred,which were succesfully treated by local dressing changes.Conclusion:Olecranon fracture associated with posterior dislocation of elbow is a complex injury of elbow joint,often accompanied by ulnar coronoid process and radial head fracture.In the treatment of olecranon fracture associated with posterior dislocation of the elbow,the correct reduction sequence was used to fix the fracture blocks in turn,and the treatment of the ulna coronoid process was paid attention to,and the anatomical shape of the incisurae semilunaris of the ulna olecranon was restored,and the satisfactory clinical effect could be obtained by using the anatomic plate fixation.The hinges can be used to assist the external fixation technique.After the operation,the patients can perform active and standardized elbow joint exercise to reduce the complications and improve the function of the elbow joint.