The Journal of the Korean Society of Fractures Vol.11, No.3, July, 1998 Department of Orthopaedic Surgery, College of Medicine Chungnam National Unive

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1 The Journal of the Korean Society of Fractures Vol11, No3, July, 1998 Department of Orthopaedic Surgery, College of Medicine Chungnam National University Hospital, Taejon, Korea and Taejon Sungshim General Hospital We treated 26 cases(25 patients) olecranon fractures operatively with Kirschner wire and tension band wiring technique from January 1993 to December 1995 The Kirschner wire fixation methods in our study were either bicortical fixation(15 cases) or intramedullary fixation(11 cases) We retrospectively reviewed clinical results according to Mayo elbow performance index and starting time of full range of motion(rom) exercise We analyzed relationship between the clinical results of the cases with cast immobilization and those without cast immobilization We also compared Kirschner wire fixation methods in the respect of clinical results, full ROM exercise starting time and complications The results were as follows 1 Clinical results were excellent or good in 25 cases(96%) according to Mayo elbow performance index Full ROM exercise starting time was within 2weeks in 10 cases, between : 640 ( ) Tel : 042) , 7342, 7343 Fax : 042)

2 weeks in 11 cases, between 5-6weeks in four cases and after 6weeks in one case Full ROM exercise starting time was significantly different(p=0016) with clinical results statistically and there was statistically high significant difference(p=00025) between clinical results and cast immobilization or not 2 Clinical results of bicortical fixation group was not significantly different from those of intramedullary fixation group and there was no significant difference between full ROM exercise starting time and Kirschner fixation methods statistically 3 The most frequent complications were decreased ROM and loosening of the Kirschner wire There were decreased ROM In 10 cases and loosening of the Kirschner wire in 6 cases in all cases We encountered more higher incidence of complications related to intramedullary fixation method The clinical results and full ROM exercise starting time of bicortical fixation group were not significantly different with those of intramedullary fixation group statistically But more early exercise, more better clinical results and more less complications was produced in bicortical fixation group So we thought bicortical fixation method is better than intramedullary fixation method : Olecranon, Fracture, Tension band wiring F y f e 11 ),, Morrey 21 ), 50 %, Murphy 5 ) % ) (screw plus wire),, 5, 9, 6, 13, 18 ), L i s t e r 14 ) (wire loop) 1963W e b e r, V a s e y 28 ), 1976 W a d s w o r t h 27 ) K - (olecranon screw) 11 ), 1982N e t ss t r o m b e r g (Wiring), (Tension band wiring), N e t s 17, 18, 25 (Intramedullary fixation), (Plate), ), (External fixation) 1992R o w l a n db u r k h a r t 26 ) 2 K - (Excision), ( R u s h - p i n ) 13 ) 8

3 674 elbow performance index 22 ) (open up) 23 A O ) K -,,, K- 9, 23 (bicortical fixation) ) K -, K -, ( i n t r a m e d u l l a r y f i x a t i o n ) ( b i c o r t i c a l f i x a t i o n ) elbow performance index,,, K - 10, 5, 1 25, 26 0, K -,,, 5 (intramedullary fixation) 90 (Excellent), (bicortical fixation), 15, 11 (Good), (Fair) 60 7, 9 Mayo ) Type I 2 ( P o o r ) (77%), IIa 15(577%), IIb 6(231%), IIIa 2( 7 7 %) IIIb 1( 3 8 %)Type IIa 14, 6, 7 5 K , , 10, 13, 13, ,, 3 (Fig 2)K - 22 ( c o r o n o i d S P S S Mann-Whitney U test Kruskal-Wallis 1-way Anova test Mayo 45, 3 0, 15 0, , (Fig 1) K - K - p r o c e s s ) 8 7 K -, M a y o 9 0, 5

$showing Mayo type IIa olecranon fracture Immediate postoperative$ radiograph, he was treated operatively with tension band wiring and K-wire

was between 2-3 weeks after operation postoperative 12 months radiograph,

result was Fifty-three-year-old-female Preoperative simple lateral

wiring and K-wire fixation method was bicortical fixation Full ROM exercise

radiograph, showing rigid fixation state and no loosening of kirschner

4 675 Sixty-four-year-old-male Preoperative simple lateral radiograph, showing Mayo type IIa olecranon fracture Immediate postoperative radiograph, he was treated operatively with tension band wiring and K-wire fixation method was intramedullary fixation Full ROM exercise starting time was between 2-3 weeks after operation postoperative 12 months radiograph, showing loosening of kirschner wires, but full ROM was done and clinical result was Fifty-three-year-old-female Preoperative simple lateral radiograph, showing Mayo type IIa olecranon fracture Immediate postoperative radiograph, she was treated operatively with tension band wiring and K-wire fixation method was bicortical fixation Full ROM exercise starting time was within 2 weeks after operation postoperative 15 months radiograph, showing rigid fixation state and no loosening of kirschner wires Full ROM was done and clinical result was excellent

5 676 Data on the patients Gender, Case age at op(yrs) Fx Fx Fx Associated Same elbow side mechanism classification injuries injuries Op name 1 M,22 Rt TA type IIa L/E No Bicortical fixation 2 M,24 Lt TA type I L/E No Bicortical fixation 3 M,26 Rt TA type IIa No No Bicortical fixation 4 M,27 Lt fall down type IIa brain, facial bone No intramedullary fixation 5 Rt fall down type IIa No No intramedullary fixation 6 M,31 Rt TA type IIa pelvis, sacrum No Bicortical fixation 7 M,32 Lt TA type IIIa L/E Lat condyle Fx D/L of radial head Bicortical fixation 8 F,33 Rt fall down type IIa pelvis, sacrum, L/E No Bicortical fixation 9 M,38 Rt fall down type IIb No No Bicortical fixation 10 F,42 Lt TA type IIa rib, pelvis, sacrum No Bicortical fixation 11 M,44 Rt TA type IIIb pelvis, sacrum, L/E No Bicortical fixation 12 F,42 Lt TA type IIb contralateral U/E side wiper injury intramedullary fixation 13 M,48 Lt TA type IIb L/E intercondyle Fx Bicortical fixation 14 F,51 Lt TA type IIIa No No Bicortical fixation 15 F,53 Lt TA type IIa brain, ipsilateral humerus, L/E No Bicortical fixation 16 F,55 Lt TA type IIb No No intramedullary fixation 17 F,61 Rt slip down type IIa No No intramedullary fixation 18 F,68 Rt slip down type IIa No No Bicortical fixation 19 M,7 Lt slip down type IIa No No Bicortical fixation 20 M,20 Rt TA type IIa brain No Bicortical fixation 21 M,62 Rt fall down type IIa contralateral U/E No intramedullary fixation 22 M,24 Lt slip down type I No No intramedullary fixation 23 M,60 Lt fall down type IIb L/E No intramedullary fixation 24 M,64 Rt slip down type IIa No No intramedullary fixation 25 F,33 Rt TA type IIb ipsilateral humerus, rib No intramedullary fixation 26 F,12 Lt fall down type IIa No No intramedullary fixation TA=Traffic accident, L/E=lower extremity, U/E=upper extremity comb hair, feed, hygiene, shirt and shoe are 5 point respectively - (active-assistive), Mayo elbow performance 2 i n d e x 19, 6 1 ( 96 %) ,

6 677 Removal Cast Full ROM Range of Total Mayo elbow of int Complication or exercise Pain motion Instability Function perfomance fixator not starting time ( ) score index No No No within 2wks None full Stable Excellent Yes No No 2-3wks None full Stable Excellent Yes No No 2-3wks None full Stable Excellent Yes No No within 2wks None full Stable Excellent Yes post-traumatic arthritis, ROM limitation No 2-3wks Mild Stable Good No No No within 2wks None full Stable Excellent Yes No No within 2wks None full Stable Excellent No No No within 2wks None full Stable Excellent No No No 2-3wks None full Stable Excellent No ROM limitation No within 2wks Mild 20-full Stable Good No ROM limitation Yes 5-6wks Mild 20-full Stable Good No ROM limitation Yes after 6wks Mild Stable Fair Yes non-union, ROM limitation Yes 5-6wks Mild Stable Good Yes No No within 2wks None full Stable Excellent Yes No No within 2wks None full Stable Excellent Yes No No within 2wks Mild full Stable Excellent No non-union No 2-3wks None full Stable Excellent No No No within 2wks None full Stable Excellent Yes pin prominence No 2-3wks None full Stable Excellent Yes ulnar neuropathy, ROM limitation No 2-3wks Mild Stable Good No ROM limitation No 2-3wks None Stable Excellent Yes pin prominence, ROM limitation Yes 5-6wks None 20-full Stable Excellent No pin prominence, ROM limitation No 2-3wks None 20-full Stable Excellent No pin prominence No 2-3wks None full Stable Excellent Yes pin prominence, ROM limitation Yes 5-6wks Mild 30-full Stable Good Yes infection, pin prominence No 2-3wks None full Stable Excellent, 4 5-6, , 1, 3 21, 18, 3 9, 1, 2-3, 11 9, 2, , 3 (2-tailed P=00025), 6 1 K -, 1 1 8, 2 ( P = ) 1,

7 ,, 4, K D a v i d 11 ),, 5, 6, 9, 13, 18, , 2- ) C o o n r a d 9 ) 3 6, ,, 2mm 2 8, 2-3 5, (sigmoid notch), 2 ) 3 14, 21 10, 6 I n g l i s 16 ) 3, 2,,, 3, 1, 10 8, Murphy 24 ) 3 100, Mayo elbow performance index 26 20, Mayo elbow performance index 10 9, 1 2, , 15, 2, K - 7(636%), ( P = ) 3( 20 %), 6 5(454%), (2-tailed P=00025) 1( 6 6 %) 2, 3 6 1, 11 )

8 679 (Tension band wiring), (Wiring), (Intramedullary fixation), K - (Plate), (External fixation) K - (Excision),, (intramedullary fixation) 2, 11, 20, 24 ), (bicortical fixation) 2 2, , , 6 1 1,, 2 8, 2-3 5, 5-6 ( 96 %) 2, 90 % C o o n r a d 9 ) 4, ) 1 82%, ) 81 % 11 8, 2 1,, , 4,, Colton 8 ) 13, Horne ) 27, Wadsworth ),, 30 W o l f g a n g ) 7, 9 Mayo ) 2 9 ),, Weseley 12 Helm ) Mayo elbow performance, i n d e x 22 ), 20, 21 ),,,,, Mayo, M a y o elbow performance index 1963W e b e rv a s e y 28 ) ,, A O K - ) 3 ) 9, 23 ) K -, Eriksson 10 ) 5 0 %,,,, 3 3 % (three point fixation) K %,,,, 26 10, 384% 1, 2 0 ) 0 4 ) 3 4 % 15 1 )

9 %, Mayo elbow performance i n d e x 20, 10 2, 11 Mayo elbow performance index 2-3, , ( P = ) 10 K - 7(636%), (2-tailed P=00025) 3( 20 %) M a c k os z a b o 20 )7 5 % 2, 15 %,,,, Hume 15 ) 4 2 % 1, ) 5 2 % 26 6, 231% 3 10( 38 4 %), 15 1( 6 6 %), 7(636%), 3( 20 %) 11 5( 45 4 %) 6 ( 23 1 %), 11 5(454%), , K -, 1 25, 26,,,,, K- 6, K ( 6 6 %) K - 1) : 1 Mayo elbow performance index, 7 : 58-64, 1994

10 681 2) : O r t h o p, 12 : , 1958, 9 15) Hume MC and Wiss DA : Olecranon fractures A : , 1996 clinical and radiologic comparison of tension band 3) : wiring and plate fixation Clin Orthop, 285 : 229-, 236, : , ) Inglis AE : The rehabilitation of the elbow after 4) : injury Instructional Course Lectures, 40 : 45-50, 1991, 10 : , ) Larsen E and Jensen CM : Tension-band wiring of 5) : olecranon fractures with nonsliding pins Report of, 8 : 20 cases Acta Orthop scand, 62 : , , ) Larsen E and Lyndrup P : Netz or Kirschner pins 6) : in the treatment of olecranon fractures? J Trauma,, 4 : , 27 : , ) MacAusland WR and Wyman ET : Fractures of 7) Cabanela ME and Morrey BF : The elbow and its the adult elbow Instructional course lectures, 24 : disorders In : Morrey BF ed Fractures of the , 1976 proximal ulna and olecranon 2nd ed Philadelphia, 20) Macko D and Szabo RM : Complications of WB Sauners Co : , 1993 tension band wiring of olecranon fractures J Bone 8) Colton CL : Fractures of the olecranon in adults Joint Surg, 69-A : , 1985 Classification and management I n j u r y, 5 : , 21) Morrey BF : Current concepts in the treatment of 1973 fractures of the radial head, the olecranon and the 9) Coonrad RW : The elbow Master techniques in coronoid Instructional Course Lectures, 44 : 175- orthopaedic surgery In : Morrey BF ed 185, 1995 Management of olecranon fractures and nonunion 22) Morrey BF, An KN and Chao EYS : The elbow 1st ed New York, Raven Press Ltd : 71-95, 1994 and it s disorders In : Morrey BF ed F u n c t i o n a l 10) Eriksson E, Sahlen O and Sandohl U : Late results evaluation of the elbow 2nd ed Philadelphia, WB of conservative and surgical treatment of fracture of Sauners Co : 86-97, 1993 the olecranon Acta Chir Scand, 113 : , ) Muller ME, Allgower M, Schneider R and 11) Fyfe IS, Mossad MM and Holdsworth BJ : Willenegger H : Manual of internal fixation 3rd ed Methods of fixation of olecranon fractures J Bone Berlin, Springer Verlag : 44-45, 1991 Joint Surg, 67-B : , ) Murphy DF, Greene WB, Gilbert JA and 12) Helm RH, Hornby R and Miller SWM : The Dameron TB : Displaced olecranon fractures in complication of surgical treatment of displaced adults Biomechanical analysis of fixation methods fracture of the olecranon I n j u r y, 18 : 48-50, 1987 Clin Orthop, 224 : , ) Horne JG and Tanzer TL : Olecranon fractures A 25) Nets P and Stromberg L : Non sliding pins in review of 100 cases J Trauma, 21 : , 1981 traction absorbing wiring of fractures A modified 14) Howard JL and Urist MR : Fracture-dislocation of technique Acta Orthop scand, 53 : , 1982 the radius and the ulna at the elbow joint Report of a 26) Rowland SA and Burkhart SS : Tension band case treated by excisional surgery and temporary wiring of olecranon fractures A modification of AO transfixation of the joint with a Kirschner wire C l i n technique Clin Orthop, 277 : , 1992

11 682 27) Wadsworth TG : Screw fixation of the olecranon after fracture or osteotomy Clin Orthop, 119 : , ) Weber BG and Vasey H : Osteosynthese bei olekranonfraktur Z Unfall Berufskr, 56 : 90-96, ) Weseley MS, Barenfeld PA and Eisenstein AL : The use of Zuelzer Hook Plate in fixation of olecranon fractures J Bone Joint surg, 58-A : , ) Wolfgang G, Gurke F, Bush D, Parenti J, Perry J, LaFollette B and Liiimars S : Surgical treatment of displaced olecranon fracture by tension band wiring technique Clin Orthop, 225 : , 1987

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