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David Ring - One of the best experts on this subject based on the ideXlab platform.
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Fracture line distribution of Olecranon fractures
Archives of Orthopaedic and Trauma Surgery, 2016Co-Authors: Bart Lubberts, Jos J. Mellema, Stein J. Janssen, David RingAbstract:Purpose The association between specific Olecranon fracture characteristics (e.g., displacement, fragmentation, subluxation) and fracture line distribution might help surgeons predict intra-articular fracture location based on fracture characteristics that can be determined on radiographs. We hypothesized that fracture mapping techniques would reveal different fracture patterns for minimally displaced fractures, displaced fractures, and fracture–dislocations of the Olecranon.
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quantitative 3 dimensional computed tomography analysis of Olecranon fractures
Journal of Shoulder and Elbow Surgery, 2016Co-Authors: Bart Lubberts, David Ring, Jos J. Mellema, Stein J. JanssenAbstract:Hypothesis/Background Olecranon fractures have variable size of the proximal fragment, patterns of fragmentation, and subluxation of the ulnohumeral joint that might be better understood and categorized on the basis of quantitative 3-dimensional computed tomography analysis. Mayo type I fractures are undisplaced, Mayo type II are displaced and stable, and Mayo type III are displaced and unstable. The last is categorized into anterior and posterior dislocations. The purpose of this study was to further clarify fracture morphology between Mayo type I, II, and III fractures. Methods Three-dimensional models were created for a consecutive series of 78 patients with Olecranon fractures that were evaluated with computed tomography. We determined the total number of fracture fragments, the volume and articular surface area of each fracture fragment, and the degree of displacement of the most proximal Olecranon fracture fragment. Results Displaced Olecranon fractures were more comminuted than nondisplaced fractures ( P = .02). Displaced fractures without ulnohumeral subluxation were smallest in terms of both volume ( P P P = .74). Anterior Olecranon fracture-dislocations created more displaced ( P = .04) and smaller proximal fragments than posterior fracture-dislocations ( P = .005), with comparable fragmentation on average ( P = .60). Discussion/Conclusion The ability to quantify volume, articular surface area, displacement, and fragmentation using quantitative 3-dimensional computed tomography should be considered when increased knowledge of fracture morphology and fracture patterns might be useful.
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combined posterior and medial plate fixation of complex proximal ulna fractures
Injury-international Journal of The Care of The Injured, 2012Co-Authors: Alida Elisabeth Anna Ochtman, David RingAbstract:Olecranon fracture dislocations often create complex fractures of the proximal ulna including fragmented coronoid fractures. Olecranon fracture dislocations can occur in an anterior or a posterior direction. In an anterior Olecranon (transOlecranon) fracture dislocation, the radius and ulna both dislocate anteriorly, the forearm relationships remain intact and the coronoid fracture is usually simple. Posterior Olecranon fracture dislocations and varus posteromedial rotational injuries can have greater coronoid fragmentation. Coronoid fragmentation can be difficult to repair with a posterior plate and screws alone. The recently recognised fractures of the anteromedial facet of the coronoid are typically secured with a medial plate and screws, usually acting as a buttress plate. Recently, we have begun treating complex proximal ulna fractures – particularly those with fragmentation of the coronoid – with combined posterior and medial plating of the proximal ulna.
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anterior Olecranon fracture dislocations of the elbow in children a report of four cases
Journal of Bone and Joint Surgery American Volume, 2009Co-Authors: Thierry G Guitton, Robert G H Albers, David RingAbstract:A subset of Olecranon fractures with loss of normal articular apposition (subluxation or dislocation) is recognized in adults as anterior and posterior Olecranon fracture-dislocations1-6, but such injuries in skeletally immature patients have been rarely described7-9. The anterior Olecranon fracture-dislocation may resemble an anterior Monteggia lesion in that there is anterior dislocation of the radial head with respect to the capitellum; however, the forearm (the radioulnar relationship) remains intact and the injury is primarily to the ulnohumeral joint by means of disruption of the trochlear notch (Figs. 1-A and 1-B). The coronoid is fractured in approximately half of the patients, the radial head is rarely injured, and the collateral ligaments are generally spared10. Olecranon fractures are relatively uncommon in skeletally immature patients11-13, and we were able to identify the cases of only three skeletally immature patients with an apparent anterior Olecranon fracture-dislocation reported in the literature7-9. Figs. 1-A and 1-B Drawings differentiating between anterior Olecranon fracture-dislocation and anterior Monteggia injuries. Fig. 1-A In the anterior Olecranon fracture-dislocation, the proximal radioulnar joint remains aligned and intact, but there is an anterior dislocation of the radiocapitellar joint along with the rest of the forearm. Fig. 1-B In the anterior Monteggia fracture, there is a fracture of the ulna with anterior dislocation of the radial head. We identified four skeletally immature patients with an anterior Olecranon fracture-dislocation from a fracture registry. This report describes the injury characteristics, treatment methods, and results of these four patients. ### Materials and Methods Between 1974 and 2002, all fractures treated at our institution were entered into a database …
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Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus
Journal of Orthopaedic Trauma, 2004Co-Authors: David Ring, Lawrence V Gulotta, Kingsley R Chin, Jesse B JupiterAbstract:Abstract Although Olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an Olecranon osteotomy may help limit complications. This paper describes a technique for Olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the Olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the Olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic Olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used.
Bernard F Morrey - One of the best experts on this subject based on the ideXlab platform.
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the distal triceps tendon insertional anatomy implications for surgery
JSES Open Access, 2017Co-Authors: Raul Barco, Pablo Sanchez, Mark E Morrey, Bernard F Morrey, Joaquin SanchezsoteloAbstract:Background Improved knowledge of the distal triceps insertion is needed as a result of an increase in procedures involving this area, including distal triceps repair, posterior capsulectomy, and Olecranon tip osteotomy for coronoid reconstruction. Materials and methods Five pair-matched upper limbs were dissected to study the morphology and dimension of the distal triceps tendon, triceps tendon insertion, capsular insertion on the Olecranon, and triceps lateral retinaculum. Muscle origins of the triceps insertions were identified proximally. Results Three distinct insertional areas were found in the Olecranon corresponding to the posterior capsular insertion, the deep muscular portion, and the superficial tendinous portion of the triceps with areas of 1.5, 1.2, and 2.8 cm 2 , respectively. The deep muscular head corresponded to the medial head of the triceps and the tendinous portion corresponded to the long and lateral heads and correlated with the height of the specimen. The triceps width at insertion was 2.6 ± 0.5 cm (standard deviation), and the triceps lateral retinaculum extended the tendon laterally for 2.5 ± 0.7 cm. The tendinous portion of the triceps tendon extended proximally 15.3 ± 1.4 cm. The triceps inserted at a mean of 1.1 cm from the tip of the Olecranon. Conclusions The distinct insertional heads of the triceps provides additional knowledge that can aid in diagnosing and treating partial triceps tears. In addition, a safe zone for capsulectomy and Olecranon tip osteotomy is described that can be used to increase the safety of these procedures.
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partial posteromedial Olecranon resection a kinematic study
Journal of Bone and Joint Surgery American Volume, 2003Co-Authors: Srinath Kamineni, Neal S Elattrache, Hirotsune Hirahara, Stanislaw Pomianowski, Patricia G Neale, Shawn W Odriscoll, Bernard F MorreyAbstract:Background: The posteromedial aspect of the Olecranon process is a site of impingement and subsequent osteophyte development in throwing athletes. Treatment with debridement, with resection of osteophytes and varying amounts of normal Olecranon bone, is common. We found no reports in the literature concerning the effects of resecting different amounts of normal bone from the posteromedial aspect of the Olecranon. We hypothesized that excessive resection would increasingly alter elbow kinematics and that an optimum amount of Olecranon resection could be identified. Methods: We investigated the kinematic effects of increasing valgus and varus torques and posteromedial Olecranon resections, in twelve cadaveric elbows, with use of an electromagnetic tracking device. Two valgus and two varus torques were applied, and three sequential resections were performed in 3-mm steps from 0 mm to 9 mm. Statistical analyses included paired t tests, 95% confidence intervals, a one-factor analysis of variance with repeated measures, and a post hoc test when significance was established. Results: Sequential partial resection of the posteromedial aspect of the Olecranon resulted in stepwise increases in valgus angulation with valgus torque. Clear differences were seen at each level of resection. A pattern of increased valgus angulation also was seen in association with increased valgus torque. Increased valgus torque resulted in a trend toward increased axial internal rotation of the ulna, whereas increased osseous resection resulted in a decrease in the absolute degree of internal rotation or, in some specimens, increased external rotation. Conclusions: Although no single critical amount of Olecranon resection was identified, valgus angulation of the elbow increased in association with all resections, with a marked increase occurring in association with a 9-mm resection. Our findings challenge the rationale of removing any amount of normal Olecranon bone in throwing athletes as doing so may increase strain on the medial collateral ligament. The implications for the professional throwing athlete are important, and we recommend that bone removal from the Olecranon be limited to osteophytes, without the removal of normal bone.
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surgical treatment of aseptic Olecranon bursitis
Journal of Shoulder and Elbow Surgery, 1997Co-Authors: Nathaniel J Stewart, James B Manzanares, Bernard F MorreyAbstract:Most cases of aseptic Olecranon bursitis respond to conservative treatment, yet some will develop a chronic bursitis with sufficient symptoms to warrant surgery. Over a 10-year period 21 cases of aseptic Olecranon bursitis were treated surgically at our institution. Surveillance was a minimum of 2 years and averaged 5.2 years. The procedure provided complete and long-term relief in only 40% (two of five) of patients with rheumatoid arthritis, whereas 94% (15 of 16) of the patients without rheumatoid arthritis did well (p = 0.028, Fisher's Exact test). No patients had deep infection or draining wounds. Properly performed surgical treatment of aseptic Olecranon bursitis appears to offer long-lasting symptomatic relief to patients without rheumatoid arthritis.
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biomechanical analysis of tension band fixation for Olecranon fracture treatment
Journal of Shoulder and Elbow Surgery, 1996Co-Authors: Scott H Kozin, Lawrence J Berglund, William P Cooney, Bernard F MorreyAbstract:This study assessed the strength of various tension band fixation methods with wire and cable applied to simulated Olecranon fractures to compare stability and potential failure or complications between the two. Transverse Olecranon fractures were simulated by osteotomy. The fracture was anatomically reduced, and various tension band fixation techniques were applied with monofilament wire or multifilament cable. With a material testing machine load displacement curves were obtained and statistical relevance determined by analysis of variance. Two loading modes were tested: loading on the posterior surface of Olecranon to simulate triceps pull and loading on the anterior Olecranon tip to recreate a potential compressive loading on the fragment during the resistive flexion. All fixation methods were more resistant to posterior loading than to an anterior load. Individual comparative analysis for various loading conditions concluded that tension band fixation is more resilient to tensile forces exerted by the triceps than compressive forces on the anterior Olecranon tip. Neither wire passage anterior to the K-wires nor the multifilament cable provided statistically significant increased stability.
Jennifer Moriatis Wolf - One of the best experts on this subject based on the ideXlab platform.
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clinical management of Olecranon bursitis a review
Journal of Hand Surgery (European Volume), 2021Co-Authors: Nzuekoh Nchinda, Jennifer Moriatis WolfAbstract:Olecranon bursitis is a disease characterized by inflammation of the Olecranon bursa, most often due to microtrauma. Although it is a common condition, there is a lack of evidence-based recommendations for the management of nonseptic Olecranon bursitis. The condition is often self-limited and resolves with conservative methods such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications. Older studies have shown resolution of symptoms with intrabursal corticosteroid injections and surgical bursectomy. More recent literature has demonstrated adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic Olecranon bursitis. In order to better tailor decision-making, it is important that hand surgeons understand the comparative efficacies of each option for management of nonseptic Olecranon bursitis.
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Olecranon fracture through persistent Olecranon apophysis in a 21 year old male a case report and systematic review of the literature
The Journal of Hand Surgery, 2020Co-Authors: Jonathan Twu, David C Landy, Jennifer Moriatis WolfAbstract:Traumatic fractures involving an ununited Olecranon apophysis in adults have been rarely documented in the literature. We present the case of a 21-year-old male wrestler with an elbow injury after a fall. Imaging revealed an acute fracture of the Olecranon with sclerotic rounded edges indicating an injury through a persistent Olecranon apophysis. Open reduction and internal fixation was performed with plate fixation and bone grafting with radiographic and clinical healing at 6 weeks. Review of the literature revealed 5 case reports showing high rates of non-union with tension band constructs while plate and screw fixation had no incidence of nonunion. Fractures through an ununited Olecranon apophysis are successfully treated with plate and screw fixation with bone grafting.
Takuya Matsumoto - One of the best experts on this subject based on the ideXlab platform.
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reverse oblique Olecranon fracture
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: T Iga, T Karita, W Sato, Hiroshi Okazaki, T Tatsumi, C Touhara, T Nishikawa, I Nagai, M Ushita, Takuya MatsumotoAbstract:Introduction In oblique Olecranon fracture, fracture line begins in the trochlear notch and proceeds distally to the dorsal cortex of the ulna. We have experienced a nonunion of reverse oblique fracture. Hypothesis Reverse oblique Olecranon fracture has instability. Materials & Methods 130 patients with an Olecranon fracture were retrospectively evaluated. Inclusion criteria are that fracture line begins at the base of the coronoid process, distal portion of the trochlear notch, and proceeds proximally to the dorsal cortex of the ulna on the lateral radiograph. Fractures with articular comminution were excluded. Results Seven patients met the criteria. They were associated with local injuries: anterior translation of the proximal radius and ulna, fracture of the medial epicondyle or the lateral condyle of the humerus. One out of five patients treated with tension band wiring (TBW) was revised with screw fixation because of nonunion. Discussion The associated injuries suggested the anterior and valgus instability. A nonunion case suggests a requirement of more secure fixation. However, these findings are common in distal Olecranon fracture. Therefore, the instability in our series is due to the distal location of fracture on the trochlear notch rather than reverse obliquity. The reverse obliquity attributes to small proximal fragment. Conclusion Reverse oblique Olecranon fracture has instability because of its distal location. It should be distinguished from simple, stable fracture.
S. C. Deshmukh - One of the best experts on this subject based on the ideXlab platform.
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ununited fracture of the Olecranon in a rheumatoid elbow is total elbow replacement and simultaneous internal fixation the answer
Injury-international Journal of The Care of The Injured, 2002Co-Authors: B A Kumar, G Leetsangtan, S. C. DeshmukhAbstract:Transverse fractures of the Olecranon can be reliably treated with tension band wiring. However, complications have been reported with this procedure [1–3]. The scope for complications is increased in the presence of pre-existing disease such as rheumatoid arthritis. We report a case of failure of fixation of an oblique fracture of the Olecranon in a patient with rheumatoid arthritis of the elbow treated with tension band wiring. This was subsequently successfully treated with total elbow replacement. The elbow was approached through the ununited fracture of the Olecranon using an Olecranon osteotomy type of approach. Following the total elbow replacement the Olecranon was fixed using the tension band wiring technique. To our knowledge such a case has not been reported.
