- Discussion:
- in elderly pts w/ comminuted frx, excision of up to 50% of olecranon can be well tolerated (no instability)
- if distal surface of semilunar notch of ulna & coronoid are not injured upto 80% of olecranon may be excised w/o producing instability;
- Indications for Excision of proximal fragment & reattachment of triceps:
- elderly patients
- frx must be proximal to middle of trochlear notch ( < 50-80% of joint)
- difficult frx anatomy
- minimal functional demands;
- desire for a single operative procedure;
- Contra-indications to Excision:
- any ligamentous or radial head instability (Type III: frx)
- coronoid process frx (implies disruption of anterior soft tissues);
- Treatment:
- surgical approach:
- plan to secure the triceps as close as possible to the articular surface (as opposed to the posterior ulnar surface), so that the triceps tendon acts as
a posterior sling for the elbow joint, promoting stability;
- use non absorbable sutures;
- Post Op:
- post-operative regimen of 3 weeks immobilization followed by protected ROM results in ROM from 10 to 120 deg flexion w/o instability
Operative treatment of olecranon fractures. Excision or open reduction with internal fixation.
Excision and advancement in the treatment of comminuted olecranon fractures.