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Late treatment of non-union of fracture of the olecranon
419
Case reports
Late treatment
of non-union of fracture of the olecranon
M. A. Waldram Royal Orthopaedic
Hospital, Birmingham
K. M. Porter Birmingham
Accident Hospital
CASE REPORT A 32-year-old man was referred by his general practitioner because of lack of active extension of the elbow due to an old injury. The patient remembered a fall and fracture of the elbow some 26 years previously. This had been treated by plaster splintage in a position of full extension for 6 weeks. Examination revealed wasting of the triceps muscle and a bony prominence 3cm above the elbow joint. There was no active extension at the elbow joint. The range of flexion was from 5” to 130”. Pronation and supination were unrestricted. Radiographs revealed an ununited fracture of the olecranon process of the ulna (Fig. 1). The separate fragment was excised, the triceps insertion was reconstructed with a V-Y plasty and was sutured to the ulna (Fig. 2). The elbow joint was splinted in plaster in full extension. The position was altered to flexion by serial plasters, commencing after 3 weeks. The postoperative range of movement was from 10” to 130”. Active extension was MRC power grade 4-5, 5 months after the operation.
DISCUSSION More than 50 per cent of the olecranon process of the ulna may be excised without compromising stability
Fig. 1. Late non-union
(Wadsworth, 1982). Total excision of the proximal fragment was recorded by McKeever and Buck (1947). Dunn (1939) described two patients treated primarily by excision of the fragment with reconstruction of the triceps’ insertion. Hey Groves (1939) reported the loss of leverage at the elbow and weakened triceps’ action that results from such treatment. Perkins (1936) recommended early movement even with a distracted fracture. However, loss of movement and pain may result from such treatment (Watson-Jones, 1982). Excision of the fragment is contraindicated in the Wadsworth type IV injury, because removal of the fragment results in radiohumeral instability. In this case of non-union of a fracture of the olecranon the patient was treated 26 years after injury. The patient had gone to his general practitioner because his loss of active extension meant he was having difficulty in finding manual employment. The loss of active extension was rectified by removal of the fragment and reconstruction of the triceps’s insertion. The time in plaster after surgery was 6 weeks and was followed by active use. The function was improved considerably.
of fracture of the olecranon.
Injury: the British Journal of Accident Surgery (1987) Vol. 18/No. 6
Fig. 2. Radiograph after excision of the fragment and reconstruction of the triceps’s insertion.
Acknowledgements We would like to thank Mr C. P. Cotterill for allowing
us to present this case, the Department of Medical Illustration at Birmingham Accident Hospital for the illustrations and Miss D. Mason for her secretarial assistance.
REFERENCES Dunn N. (1939) An operation for fractures of the olecranon. Br. Med. J. 1, 214.
Hey Groves E. W. (1939) Fractures of olecranon. Br. Med. J. 1, 296. McKeever F. M. and Buck R. M. (1947) Fracture of the olecranon process of ulna treated by excision of fragment and triceps repair. Br. Med. J. 1, 13.5. Perkins G. (1936) Fracture of olecranon. Br. Med. J. 2,668. Wadsworth T. G. (1982) The Elbow. Edinburgh, Churchill Livingstone, 203 Watson-Jones (1982) Fractures and Joint Injuries. Edinburgh, Churchill Livingstone, 651. Paper accepted 22 January 1987.
Aequesfsfor reprintsshould be addressed to: Mr M. A. Waldram, Royal Orthopaedic Hospital, Woodlands, Northfield, Birmingham B31 2AP.
Case reports
Late treatment
of non-union of fracture of the olecranon
M. A. Waldram Royal Orthopaedic
Hospital, Birmingham
K. M. Porter Birmingham
Accident Hospital
CASE REPORT A 32-year-old man was referred by his general practitioner because of lack of active extension of the elbow due to an old injury. The patient remembered a fall and fracture of the elbow some 26 years previously. This had been treated by plaster splintage in a position of full extension for 6 weeks. Examination revealed wasting of the triceps muscle and a bony prominence 3cm above the elbow joint. There was no active extension at the elbow joint. The range of flexion was from 5” to 130”. Pronation and supination were unrestricted. Radiographs revealed an ununited fracture of the olecranon process of the ulna (Fig. 1). The separate fragment was excised, the triceps insertion was reconstructed with a V-Y plasty and was sutured to the ulna (Fig. 2). The elbow joint was splinted in plaster in full extension. The position was altered to flexion by serial plasters, commencing after 3 weeks. The postoperative range of movement was from 10” to 130”. Active extension was MRC power grade 4-5, 5 months after the operation.
DISCUSSION More than 50 per cent of the olecranon process of the ulna may be excised without compromising stability
Fig. 1. Late non-union
(Wadsworth, 1982). Total excision of the proximal fragment was recorded by McKeever and Buck (1947). Dunn (1939) described two patients treated primarily by excision of the fragment with reconstruction of the triceps’ insertion. Hey Groves (1939) reported the loss of leverage at the elbow and weakened triceps’ action that results from such treatment. Perkins (1936) recommended early movement even with a distracted fracture. However, loss of movement and pain may result from such treatment (Watson-Jones, 1982). Excision of the fragment is contraindicated in the Wadsworth type IV injury, because removal of the fragment results in radiohumeral instability. In this case of non-union of a fracture of the olecranon the patient was treated 26 years after injury. The patient had gone to his general practitioner because his loss of active extension meant he was having difficulty in finding manual employment. The loss of active extension was rectified by removal of the fragment and reconstruction of the triceps’s insertion. The time in plaster after surgery was 6 weeks and was followed by active use. The function was improved considerably.
of fracture of the olecranon.
Injury: the British Journal of Accident Surgery (1987) Vol. 18/No. 6
Fig. 2. Radiograph after excision of the fragment and reconstruction of the triceps’s insertion.
Acknowledgements We would like to thank Mr C. P. Cotterill for allowing
us to present this case, the Department of Medical Illustration at Birmingham Accident Hospital for the illustrations and Miss D. Mason for her secretarial assistance.
REFERENCES Dunn N. (1939) An operation for fractures of the olecranon. Br. Med. J. 1, 214.
Hey Groves E. W. (1939) Fractures of olecranon. Br. Med. J. 1, 296. McKeever F. M. and Buck R. M. (1947) Fracture of the olecranon process of ulna treated by excision of fragment and triceps repair. Br. Med. J. 1, 13.5. Perkins G. (1936) Fracture of olecranon. Br. Med. J. 2,668. Wadsworth T. G. (1982) The Elbow. Edinburgh, Churchill Livingstone, 203 Watson-Jones (1982) Fractures and Joint Injuries. Edinburgh, Churchill Livingstone, 651. Paper accepted 22 January 1987.
Aequesfsfor reprintsshould be addressed to: Mr M. A. Waldram, Royal Orthopaedic Hospital, Woodlands, Northfield, Birmingham B31 2AP.