The treatment of olecranon fractures in adults. 2017

A J Powell, and O M Farhan-Alanie, and J K Bryceland, and T Nunn
Department of Trauma and Orthopaedic Surgery, Royal Alexandra Hospital, Corsebar Rd, Paisley, PA2 9PN, UK. ajpowell@doctors.org.uk.

Olecranon fractures are common. They are usually managed surgically with open reduction and either tension band wiring or plate fixation. Currently, there are few studies comparing fracture treatments. We aim to review the available literature to guide the orthopaedic surgeon on the management of these fractures. A literature review of peer-reviewed publications in international orthopaedic journals detailing olecranon fracture treatment was conducted. An additional focus was placed on the evidence base for and surgical outcomes of tension band wiring for common two-part fractures. Our novel illustrations aim to educate the reader, and our treatment algorithm provides guidance for management. 10% of all upper limb fractures involve the olecranon, and most are simple two-part injuries. These should be managed with tension band wire constructs. Non-displaced fractures can be treated conservatively. Displaced complex injuries necessitate locking plate fixation. Currently, there exits a lack of studies comparing these treatments. There may be an emerging role for intramedullary nail fixation. Non-operative management in the elderly comorbid patient remains controversial. Prospective, randomised controlled trials of matched patients and fracture patterns comparing operative techniques are needed as there is a lack of level I/II evidence to support the use of one implant over another.

UI MeSH Term Description Entries
D009985 Orthopedics A specialty which utilizes medical, surgical, and physical methods to treat and correct deformities, diseases, and injuries to the skeletal system, its articulations, and associated structures.
D004551 Elbow Joint A hinge joint connecting the FOREARM to the ARM. Elbow Joints,Joint, Elbow,Joints, Elbow
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014458 Ulna Fractures Fractures of the larger bone of the forearm. Fracture, Ulna,Fractures, Ulna,Ulna Fracture
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice
D056740 Olecranon Process A prominent projection of the ulna that articulates with the HUMERUS and forms the outer protuberance of the ELBOW JOINT. Olecranon,Process, Olecranon
D019317 Evidence-Based Medicine An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006) Medicine, Evidence-Based,Evidence Based Medicine,Medicine, Evidence Based

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