Olecranon Fractures

Michael B. Millis, MD James R. Kasser, MD

Open Reduction Internal Fixation

Sterile Instruments/Equipment

Depends on planned tension band, screw, or plate and screw technique needed.

Smooth K-wires are most often used for the tension band technique
Large diameter nonabsorbable suture for the suture tension band
Cerclage wiring for the wire tension band if preferred
AO 4.0, 4.5, 6.5 cannulated screws, and washers depending on the patient size and fracture type if compression screw fixation is indicated
AO small fragment set, if plating with appropriate care
Power drill
Fluoroscopy
Radiolucent table

Figure 10-1 ▪ Displaced olecranon fracture in skeletally immature patient.

Figure 10-2 ▪ OR set up with supine position, external rotation shoulder.

Patient Positioning

Supine with arm on a radiolucent table, if sufficient external rotation glenohumeral joint allows for easy exposure and fixation. Most common position (Figure 10-2)
- Bring patient to the edge of the OR table
- Sterile or nonsterile tourniquet high in upper arm
- C-arm perpendicular to the affected limb and parallel to the patient
- Surgeon and assistant on either side of the table
Lateral decubitus with arm support alternative position (Figure 10-3)
Prone with arm mobile for flexion and extension imaging and support if difficult to achieve in supine or lateral decubitus

Figure 10-3 ▪ Lateral decubitus positioning after (A) sterile prep and (B) draping.

Surgical Approaches

Expose proximal ulna with curvilinear incision from the distal humerus olecranon fossa region to at least 3 to 4 cm beyond the fracture site.
Curve incision is made laterally at olecranon to avoid scar directly over olecranon and protect posteromedial ulnar nerve (Figure 10-4)
Elevate fasciocutaneous flaps medially and laterally to see the full extent of fracture (Figure 10-5)

Reduction and Fixation Techniques

Reduction

Feb 5, 2020 | Posted by drzezo in ORTHOPEDIC | Comments Off

Musculoskeletal Key