Olecranon fracture
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PURPOSE OF THE STUDY Olecranon fractures in skeletally immature patients are rather rare and represent up to 7% of elbow skeletal injuries. Although the majority of olecranon fractures is constituted by undisplaced fractures treated conservatively with good outcomes, a few of them require surgery. The aim of the study was to compare two different approaches of surgical treatment - the open reduction with tension band wiring - cerclage (ORCe) and the closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS 37 patients (28 boys, 9 girls) were included in the retrospective multicentric study. The patients were treated at two different institutions (the Clinic of Paediatric Surgery, Orthopaedics and Traumatology, the University Hospital Brno and the Department of Paediatric Surgery and Traumatology, the University Hospital Hradec Králové, Czech Republic). 17 patients underwent the ORCe procedure, while 20 patients were treated using the CRPP method. Different parameters were statistically compared in the groups (demographic data, data concerning the course of the therapy, outcome of the therapy in terms of movements' restrictions and complications such as osteosynthesis failure and infection). RESULTS Both the groups were comparable in terms of demographic data because no statistically significant difference was observed in terms of the age (p = 0.082), the affected site (p = 1.000) and the gender (p = 0.462). Statistically significant difference between these two groups was found in the interval between the implementation and the removal of the osteosynthetic material (p < 0.001) and in the length of cast immobilisation (p = 0.047). The number of patients with movement restriction up to 10° was statistically significantly higher in patients who underwent the CRPP procedure (p = 0.040), but no statistically significant difference was seen between these two groups in terms of movement restriction more than 10° (p = 0.609). One revision surgery was performed in the CRPP group, however with no statistical significance (p = 0.350). DISCUSSION The multicentric study included 37 children, who underwent surgical treatment of a displaced olecranon fracture. Compared to the studies dealing with this topic the number of patients included in this study is relatively high. It advocates the possibility of using the CRPP method as a good alternative to the gold-standard ORCe technique because no difference in terms of the number of revision surgeries and the clinically important movement restriction of more than 10° were seen. It also brings along advantages such as a simple surgical technique, good functional and cosmetic effects, reducing the risk of ischemic insult of growth plate and the possibility of osteosynthetic material removal at an outpatient department with no need for general anaesthesia. The risk of a higher radiation exposure of both the patient and the surgical team should be considered as a disadvantage of the closed method. CONCLUSIONS The mini-invasive CRPP appears to be a good alternative option to the ORCe method for the treatment of isolated olecranon fractures in children offering the advantages such as avoiding extensive open procedure and simple implants removal. Key words:children, olecranon, fracture, tension band wiring - cerclage, percutaneous pinning, elbow.
- MeSH
- dítě MeSH
- fraktury humeru diagnóza chirurgie MeSH
- hodnocení výsledků zdravotní péče MeSH
- kostní dráty MeSH
- lidé MeSH
- loketní kloub * diagnostické zobrazování chirurgie MeSH
- olecranon * diagnostické zobrazování zranění chirurgie MeSH
- otevřená repozice fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- poranění lokte MeSH
- radiografie metody MeSH
- srovnávací výzkum účinnosti MeSH
- uzavřená repozice fraktury * škodlivé účinky metody MeSH
- věkové faktory MeSH
- výběr pacientů MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
PURPOSE OF THE STUDY The standard procedure in treating distal humerus fractures is the open reduction internal fixation (ORIF). The surgical approach is still a matter of discussion. The submitted study focuses on comparing the conventional approach with olecranon osteotomy and the paratricipital approach. MATERIAL AND METHODS Since January 2015 a total of 18 patients have been operated on, who met the inclusion criteria of the study on type C distal humerus fracture without the use of olecranon osteotomy. This group of patients was subsequently compared with a control group of patients in whom the olecranon osteotomy was performed in the period 2010-2015. The patients were assessed using the Mayo Elbow Performance Score (MEPS), the range of motion and complications, including the need for removal of osteosynthesis material. RESULTS The control group (Group 1), in which 22 patients operated directly by olecranon osteotomy were assessed, was compared with the group of operated patients (Group 2) consisting of 18 patients. When comparing the range of motion and MEPS, no significant difference was found between the groups (flexion: p = 0.519, extension: p = 0.382, MEPS: p = 0.110). Unlike Group 2, in Group 1 the osteosynthesis material of cerclage was removed in 13 cases. DISCUSSION Apart from the complexity of fracture and choice of fixation technique, it is the choice of surgical approach which constitutes another factor having effect on the final elbow function. Basically, the approaches to distal humerus can be divided into 4 groups, namely splitting, reflecting and sparing approaches and olecranon osteotomy which offers the best access to the fracture during fixation and which is recommended by many experts in treating these complex fractures which, however, has its disadvantages such as longer duration of surgery, longer healing time, non-union or malunion, protruding osteosynthesis material and secondary procedures necessary to remove the material. CONCLUSIONS In our study no significant difference in functional outcomes was found between the examined approaches. A difference was identified with respect to protruding material of the cerclage and soft tissue irritation with subsequent removal of osteosynthesis material after the olecranon osteotomy. Key words:distal humerus fracture, internal fixation, surgical approach, olecranon osteotomy, paratricipital approach, tricepssparing approach, triceps reflecting anconeus pedicle approach.
- MeSH
- algoritmy MeSH
- fraktury humeru * chirurgie MeSH
- humerus MeSH
- lidé MeSH
- olecranon * MeSH
- rozsah kloubních pohybů MeSH
- vnitřní fixace fraktury * MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Elbow injuries continue to rise with increased athletic activity and life expectancy. Knowledge of anatomy and biomechanics of this sophisticated joint, various injury patterns, and the implication of injury to the static and dynamic stabilizers will result in improvement in specific diagnosis, and therapy. The surgical treatment of trauma to the adult elbow has evolved rapidly in recent years and many useful concepts and techniques have been established. This paper reviews the published scientific data and current opinion available to guide patient care.
- MeSH
- fraktury humeru diagnóza chirurgie komplikace terapie MeSH
- fraktury ulny diagnóza chirurgie terapie MeSH
- Haplosporida MeSH
- lidé MeSH
- loketní kloub chirurgie MeSH
- olecranon zranění MeSH
- poranění lokte MeSH
- vnitřní fixace fraktury metody škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: Several methods to restore the appropriate length of the humerus in the case of proximal humeral fractures treated by hemiarthroplasty have been previously published. Our study evaluates the possibility of using the medial calcar of humerus for humeral length reconstruction not based on preoperative planning. METHODS: Preparations of 320 dry humeral bones were used for the purpose of the study. Points of interest were marked on each bone: the most proximal point of the humeral head, the crest of greater tuberosity, diameters of the head, the anatomical and surgical necks. Proximal parts of bones were then scanned from two angles with a digital camera and all measurements were performed on calibrated photographs. We compared accuracy in humeral length reconstruction using insertion of the pectoralis major and the area of medial calcar where usually a fracture develops. RESULTS: The distance between the top part of the humeral head and the insertion of pectoralis major was 54.1 ± 6.0 mm. The distance between the lateral margin of the anatomical neck and the medial calcar was 51.4 ± 4.3 mm. We compared these data with diameters of the humeral head. CONCLUSIONS: The site of the fracture can be used for the reconstruction of the humeral length with greater accuracy than area of the pectoralis major insertion. We suggest that to obtain the final distance between the lateral margin of the artificial head and medial calcar of the fracture 2-3 mm should be added to the diameter of the head.
- MeSH
- algoritmy MeSH
- fraktury humeru chirurgie MeSH
- hemiartroplastika MeSH
- humerus anatomie a histologie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: The appropriate treatment of pulseless pink supracondylar humerus fractures (SCHF) remains controversial. In this study, the outcomes of two treatment approaches (with and without vascular surgery) were compared. MATERIAL AND METHODS: This was a retrospective multicenter study of patients with pulseless pink SCHFs treated in ten pediatric surgery, trauma, or orthopedics departments in the Czech and Slovak Republic between 2014 and 2018. RESULTS: Of the total 3608 cases of displaced SCHF, 125 had the pulseless pink SCHF. Of those, 91% (114/125) did not undergo vascular surgery and 9% (11/125) underwent vascular surgery. The patients who did undergo vascular surgery had radial artery pulsation restored more frequently in the operating room (73% vs. 36%; p = 0.02), within 6 h (91% vs. 45%; p = 0.004), and within 24 h of surgery (91% vs. 57%; p = 0.05). However, 72 h after surgery, there was no significant difference in palpable radial artery pulsation between the vascular surgery and the non-vascular surgery groups (91% vs. 74%; p = 0.24). Additionally, no significant differences in long-term neurological (9% vs. 22%; p = 0.46) or circulatory (9% vs. 7%; p = 0.57) deficits were found between the two groups. CONCLUSION: While vascular surgery in patients with pulseless pink SCHFs is associated with a more prompt restoration of radial artery pulsation, no statistical significant differences in terms of the restoration of neurological deficits or the risks of long-term neurological or circulatory deficits were found between patients with and without vascular surgery.
PURPOSE OF THE STUDY Supracondylar humerus fracture (SCF) with dislocation is indicated for closed reduction and osteosynthesis. The method achieving the best stability is CRCPP (closed reduction and crossed percutaneous pinning), even though there is a risk of iatrogenic ulnar nerve injury. The CRLPP (closed reduction and lateral percutaneous pinning) method eliminates this risk at the cost of less stable osteosynthesis. The purpose of this study is to compare the SCF stabilisation by CRLPP with the stabilisation by CRCPP in rotationally stable fractures and to identify the risk of iatrogenic ulnar nerve injury, or the failure of osteosynthesis with recurrent dislocation of fragments. MATERIAL AND METHODS The prospective group of the patients with SCF type 1/2 (classification according to Havránek) treated in the period 2016-2018, in whom the method of osteosynthesis (number of implants, method of their insertion), resulting condition and complications (nerve injury, failure of osteosynthesis) were evaluated. In the second half of the study, in CRLPP one of the implants was inserted "quadricortically", i.e. through the olecranon fossa of the humerus (hereinafter referred to as fossa), while until then both the implants had been inserted through the radial column outside fossa. RESULTS In the period 2016-2018, 791 patients with SCF were treated at our department. In 225 cases (28.5%) the patients sustained the type 1/2 fracture and in all the cases closed reduction and percutaneous osteosynthesis were performed, namely CRCPP in 185 cases (82.2%) and CRLPP in the remaining 40 cases (17.8%). Signs of ulnar nerve injury after osteosynthesis were observed in 35 patients (15.6% of SCF 1/2), always after the use of at least one ulnar implant (18.9% of CRCPP). A failure of osteosynthesis occurred in 2 cases (0.9% of SCF 1/2), always when only lateral implants were used (5% of CRLPP). DISCUSSION In both the patients in our study in whom after CRLPP a failure of osteosynthesis with rotational dislocation occurred, the original CRLPP was performed by inserting both the implants through a single column outside fossa. Both the patients were indicated for revision reduction and osteosynthesis was subsequently performed through CRCPP. The patients healed with no further complications. In the group of patients with an ulnar nerve injury, the original condition was fully restored, after 3.6 months (range of 1-10, median 3) on average. The results of our study show the need to guide the implants inserted through the radial column divergently so that they are at the fracture line level as far apart as possible (with adequate fixation of fragments). One of the implants is inserted through fossa, i.e. quadricortically. Based on our experience, the compliance with these principles alone shall ensure adequate rotational stability of SCF of type 1/2. In CRLPP, after the insertion of implants the stability is tested under the Xray image intensifier intraoperatively so that a medial implant can be added in case of unstable osteosynthesis. CONCLUSIONS Based on the results of our study we recommend to stabilise the rotationally stable SCF (type 1/2 according to Havránek) only from the radial column (and thus eliminate the risk of iatrogenic ulnar nerve injury), provided the fracture characteristics allows so. Nonetheless, the CRLPP has its own specific rules for implant entry which have to be adhered to. Key words: supracondylar fracture of the humerus, paediatric fractures, closed reduction, percutaneous pinning, lateral percutaneous pinning, iatrogenic ulnar nerve injury, osteosynthesis failure.
Glenohumeral joint is the most frequently dislocated joint of the human body. Concomitant fractures of the coracoid process and tuberculum majus in humeral dislocation of the shoulder joint are rarely described. Concomitant fractures are results of a significant contraction of the surrounding muscles and rotator cuff during a cerebral paroxysm. Due to the small number of cases, the treatment of such injuries is not simple and it is based on an algorithm for treatment of isolated injuries of these anatomical structures. In this case report, we describe a concomitant fracture of the coracoid process and tuberculum majus during an anterior shoulder dislocation in 25-year-old patient after an epileptic seizure. The injury was treated in our department surgically, with a good functional result. The absolute Constant score for the operated arm is 95 points, the relative Constant score is 97%, DASH score 0, VAS score 0.
- MeSH
- dospělí MeSH
- fraktury kostí * komplikace MeSH
- humerus MeSH
- lidé MeSH
- luxace ramenního kloubu * komplikace chirurgie MeSH
- processus coracoideus MeSH
- ramenní kloub * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
