Operative Orthopädie und Traumatologie vol:23 issue:5 pages:438-445
OBJECTIVE: Stable fixation of simple olecranon fractures or olecranon osteotomies in order to allow early functional treatment. INDICATIONS: Simple (non-comminuted) olecranon fractures and (Chevron) osteotomies of the olecranon. CONTRAINDICATIONS: Comminuted fractures and fractures more than 40 mm distal than the tip of the olecranon are contraindications. SURGICAL TECHNIQUE: Using a slightly curved posterior approach, the fracture is anatomically reduced. The fracture is temporary stabilized using K-wires. A guiding K-wire is positioned centrally in the medullary canal in the lateral projection. The medullary canal is reamed over the K-wire. The distal part of the nail is inserted and locked. The proximal part is inserted and screwed onto the distal part to compress the fracture. For osteotomies, the distal part is inserted and locked (using the same technique as described before) prior to performing the osteotomy. At the end of the surgery, the osteotomy is reduced, the proximal part is inserted, and the osteotomy is compressed. POSTOPERATIVE MANAGEMENT: As the stability of this compressive osteosynthesis is very high, early post-operative mobilization is allowed. No immobilization is used. Depending on the soft tissue situation, active range of motion and passive stretching is initiated immediately postoperatively. RESULTS: Using this technique in 21 patients (mean age 42 years) with acute fractures or osteotomies, sound fracture healing was achieved in 19 of 21 patients. The active range of motion was 130.2° flexion, 10.6° extension deficit, and a normal pro-supination arch. In one patient, delayed union caused implant failure. In this patient, a surgical error jeopardized stability. In a second patient, a peri-implant fracture after adequate trauma made a change in therapy necessary.