An olecranon osteotomy provides the best visualization of the articular surface in complex distal humeral fractures compared with tricepssparing or tricepssplitting approaches. Olecranon osteotomy this is the colour illustration of my self dissected specimen. Technique using isoelastic tension band for treatment of olecranon fractures rebecca a. Surgical exposures of the elbow musculoskeletal key. Remove the drill sleeve and use the depth gauge to measure the screw length. Olecranon osteotomy facilitated elbow release ofer vumedi. The most popular variation of the olecranon osteotomy to date is that of the chevron osteotomy. Outcome of olecranon osteotomy in the transolecranon. Compiled by the world\u2019s leading authority on elbow surgery, chapters address the common conditions and complications encountered by orthopaedic surgeons of all levels but from the perspectives of master surgeons. Use of orthogonal or parallel plating techniques to treat distal. Biomechanical analysis of a novel plating for intraarticular distal humerus.
The ibalance hto surgical technique starts with an instrument system highly specific to the ibalance implants that creates a safety envelope with lockedin retractors, allowing the surgeon to create all cuts safely and reproducibly, while significantly reducing chances of neurovascular injury and lateral hinge fractures. This technique is suitable for simple transverse olecranon fractures or olecranon osteotomy with stability of the ulnohumeral articulation. This reference offers a stepbystep, howto approach on performing both open and arthroscopic surgeries for sportsrelated injuries of the knee, elbow, and shoulder. Fehringer, md investigation performed at the department of orthopaedic surgery and rehabilitation, university of nebraska medical center, omaha, nebraska. A new technique for olecranon osteotomy in the treatment of distal. Surgical techniques for trauma and sports related injuries of. In this approach, a v type of osteotomy is created at the mid portion of the olecranon through the region not covered by hyaline cartilage. Olecranon osteotomy approach for complex aoc fractures of.
Oct 01, 2014 orif of intercondylar fracture of humerus by olecranon osteotomy approach duration. Surgical treatment of comminuted intraarticular fractures. The comparison of tricepsreflecting anconeus pedicle and. The olecranon was reduced and held using tenaculums.
Trans olecranon chevron osteotomies cos remain the gold standard surgical approach to type c fractures of the distal humerus. The proximal and distal extension of the exposure depends on the exposure needed and the type of osteotomy planned. The surgical indication is marked displacement with rare exception for severe medical comorbidities. Revision surgery of an olecranon fracture after initial surgical treatment failure in a. The trimano fortis support arm acts as an additional surgical assistant by securely and safely holding the patients arm in any desired position during arthroscopic or open elbow surgery. This technique is associated with a high complication rate and development of an extraarticular olecranon osteotomy may be advantageous. Surgical technique all patients were prepared in the supine position and tourniquet was applied. The instruments also allow for alignment of the osteotomy to the. For complex intraarticular fractures type c, an olecranon osteotomy is preferred. Depending on the lesion and the surgical goal, the joint and the surrounding region may be approached from the lateral, posterior, medial, or anterior direction.
Olecranon osteotomy is a wellestablished technique, providing access to the distal humerus for reduction and fixation of intraarticular fractures. Next, attention was directed toward repairing the olecranon osteotomy. The patient is placed in the lateral decubitus position with the operative arm placed over an arm holder. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a. Chevronolecranon osteotomies are commonly used for the approach. The commons is a showcase for jefferson books and journals. A thorough knowledge of all anatomical structures is necessary to allow safe and practical surgical approaches to be made, and is crucial for understanding potential sites or. Surgical techniques for trauma and sports related injuries of the. Olecranon osteotomy wheeless textbook of orthopaedics. Olecranon osteotomy w sled application in approach to distal. Olecranon osteotomy is a commonly used method for obtaining adequate exposure of the articular surface in complex distal humeral fractures. A posterior approach to the elbow utilizing an olecranon.
Chapter 7 surgical exposures of the elbow bernard f. The management of intraarticular distal humeral fractures remains a difficult surgical problem. Plate fixation of olecranon osteotomies request pdf. Goulet kagan ozer introduction fractures of the olecranon constitute approximately 10% of fractures that occur about the elbow. The olecranon osteotomyfacilitated elbow release ofer. The osteotomy is performed with osteotomes and then repaired with olecranon osteotomy david a. Erpelding, md, adam mailander, otrl, robin high, mba, ma, matthew a. The apex distal chevron osteotomy was performed using an oscillating saw.
Foot and ankle technique guide metatarsal shortening. It may not fully cool the elbow below the dressing, but it is still beneficial. Next, the guidewire that had previously been placed into the olecranon shaft, prior to making the osteotomy cut, was placed. Surgical techniques for trauma and sports related injuries. Double loop tension band techniques to the classic ao tension band technique for. Extended olecranon osteotomy for revision total elbow arthroplasty article in techniques in shoulder and elbow surgery 161. A study conducted in an olecranon osteotomy model showed that wire diameter is. The osteotomy is fixed with a screw or tension band fixation. For mild deformities, a distal metatarsal osteotomy, such as a chevron osteotomy, is sufficient. The compact and lightweight device is easily attached to any or table clark rail and is ready for immediate use. The acumed osteotomy system features the ulna shortening plate which is designed to offer a lowprofile plate with builtin osteotomy reference lines and an osteotomy guide. Fractures of the olecranon process of the ulna are among the more common upper extremity fractures requiring operative intervention. The wound was thoroughly irrigated with normal saline prior to fixation of the olecranon osteotomy. A new technique for olecranon osteotomy in the treatment.
Olecranon fractures can be complex injuries presenting the treating physician with a wide array of surgical and nonsurgical options. Attach the olecranon plate proximal targeting guide 800654 to the olecranon plate 7003xx with the locking bolt. This technique for extended olecranon osteotomy provides reliable, atraumatic access to the ulnar canal, cement mantle, and component for safe extraction of a wellfixed implant. Surgical techniques of olecranon fractures sciencedirect. Although this common injury is frequently operated on, it has complications. Technique of olecranon bone grafting for surgical fixation. Technique of olecranon bone grafting for surgical fixation of. Selection of a particular osteotomy is also dependent on the surgeons familiarity and experience with the various surgical options. Olecranon locking plate surgical techniquealog infor nota bene the technique description herein is made available to the healthcare professional to illustrate the authors suggested treatment for the uncomplicated procedure. Due to the wide spectrum of fracture patterns, no single method of.
Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomyfacilitated elbow release ofer procedure were included in the. For moderate and severe deformities, a midshaft or proximal osteotomy along with a phalangeal osteotomy may be. Dec 04, 2019 olecranon fractures can be complex injuries presenting the treating physician with a wide array of surgical and non surgical options. It is published in collaboration with isakos and will be of value to students, physiotherapists, sports physicians, and orthopaedic surgeons. The triceps reflecting approach bryanmorrey for distal humerus. Outcomes following distal humeral fracture fixation with an. We also demonstrate our intraoperative management of the ulnar nerve. The polyaxial locking technology works by using two different grades of titanium. Extended olecranon osteotomy for revision total elbow. When performing the olecranon osteotomy, remember that the semilunar notch is vshaped with the central area being the thickest the site for the osteotomyabout 2 cm distal to the olecranon tip 8. Surgical treatment of comminuted intraarticular fractures of.
Rigorous adherence to the principles of good surgical technique is of no greater importance in any anatomic part than at the elbow. At each visit, anteroposterior and lateral radiographs were taken and assessed for the adequacy of the reduction, loosening of implant and progression of the union. All patients treated using an olecranon osteotomy exposure demonstrated. Olecranon osteotomy and fixation by cancellous screw openi. Satisfactory results were reported in the literature as the surgical approach and techniques for fixation with olecranon osteotomy had been. Locking screws are made of titanium alloy ti6a14v which is stronger than the pure titanium plate holes. For simple fractures and osteotomies of the olecranon. The following technique guide describes a metatarsal shortening technique using the hattrick osteotomy guide. Evolution in implant design and surgical technique has led to improved. They vary in complexity from relatively simple transverse fractures to highly comminuted and unstable fracture dislocations. Materials and methods surgical technique the patient is placed in the lateral decubitus position with the arm supported as shown in figure 2. Create a chevron osteotomy with the apex pointing distally.
The osteotomy is performed with osteotomes and then repaired with a tension band technique. In the final analysis, the preferred treatment is that which addresses the needs of the specific patient. Olecranon osteotomy w sled application in approach to distal humerus orif. A technique using highstrength braided polyester and polyethylene suture through a bone tunnel has been piloted. Disabilities associated with untreated olecranon fractures result from disruption of the extensor mechanism. As for any orthopedic procedure, the choice of the surgical approach should be based on the following criteria. Olecranon osteotomy facilitated elbow release ofer provides excellent exposure of the joint with relative minimal soft dissection and allows the surgeon to address all intrinsic and extrinsic causes of contracture in a safe and efficient manner with similar or better results compared to more traditional open or arthroscopic techniques. Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomy facilitated elbow release ofer procedure were included in the. May 01, 2000 the best method of treatment for comminuted intraarticular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in patients with osteoporosis.
The osteotomy entered the joint at the depth of the trochlear notch. Distal humerus reconstruction with olecranon osteotomy. Outcomes following distal humeral fracture fixation with. The osteotomy is performed with osteotomes and then repaired. An illustrative surgical case is also included with pertinent intraoperative and radiographic images. We describe a new technique whereby a precontoured olecranon plate is first fixed to the olecranon, and a gigli saw is used to perform the osteotomy while the plate is in place. Leaders in sports medicine offer guidance on everything from patient positioning and the latest surgical techniques through pearls and pitfalls and postoperative care. Mechanical evaluation of pin and tensionband wire factors in an. The book provides stateoftheart information on implant design and detailed guidelinesincluding treatment algorithmson specific arthroplasty procedures for arthritis, fractures, chronic dislocations, and other disorders. Determining the efficacy of screw and washer fixation as a method. The prongs in the proximal end of the plate should penetrate the triceps tendon and provide provisional fixation. Olecrenon osteotomy identify dissect out the ulnar nerve if fixationof the olecranon osteotomy by screw, drill and tap the olecranon before the osteotomy is performed. Cadaveric dissection, implantation, osteotomy, and extraction of a total elbow arthroplasty were performed using an extended olecranon osteotomy. Jul 11, 2018 selection of a particular osteotomy is also dependent on the surgeons familiarity and experience with the various surgical options.
The posterior approach through a chevron osteotomy of the olecranon is most often used and allows excellent visualisation of the distal humerus 3, 6. This video demonstrates our surgical approach to treating intraarticular distal humerus fractures as well as the use of the trimed olecranon sled for fixation of an olecranon osteotomy. When a screw is driven into a plate hole, the locking threads on the underside of the screw engage the circular lip in the hole. Compiled by the worlds leading authority on elbow surgery, chapters address the common conditions and complications encountered by orthopaedic surgeons of all levels but from the perspectives of master surgeons. The best method of treatment for comminuted intraarticular fractures of the distal humerus has long been subject to debate, particularly when the fractures occur in. Thirtyfive patients with refractory posttraumatic elbow contracture who underwent an olecranon osteotomyfacilitated elbow release ofer procedure were included in the study. Erpelding, md, adam mailander, otrl, robin high, mba, ma. A concise and consistent chapter format makes it easy to.
In this book, leading international surgeons with expertise in the field provide cuttingedge information on the surgical techniques to treat sports and trauma injuries of the elbow. T1 technique of olecranon bone grafting for surgical fixation of scaphoid fractures. Controversies in the management of intraarticular fractures. Orif of intercondylar fracture of humerus by olecranon osteotomy approach duration. The reference lines on the plate help facilitate the creation of the osteotomy when a free hand cut is preferred. It can be slightly curved to the radial side to protect the ulnar nerve. Olecranon osteotomy w sled application in approach to. Diameter 6 mm, length 40 mm 2 synthes olecranon osteotomy nail technique guide.
Surgical technique a consistent technique, except for plate. Tension band wiring of simple transverse olecranon fractures results in a high reoperation rate due to hardware problems. A straight posterior longitudinal skin incision was used just lateral to the olecranon tip. Suture repair of simple transverse olecranon fractures and. The purpose of this article is to describe a novel technique that releases posttraumatic elbow contractures through an olecranon osteotomy and report the outcomes. Drill and tap olecranon prior to performing the osteotomy. Ao surgery reference is a resource for the management of fractures, based on current clinical principles, practices and available evidence.
For the common procedures, a number of surgical technique options are presented, ensuring that the reader gains a broader perspective on this evolving surgical field. This paper describes a technique for olecranon osteotomy using an apex, distal, chevronshaped 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, figureofeight, stainless steel tension wires. The osteotomy configuration provides a large surface area for bony. Six patients 15% had accompanying fractures and two of them had concomitant head and thorax injury. Transolecranon chevron osteotomies cos remain the gold standard surgical approach to type c fractures of the distal humerus. Written by the worlds foremost shoulder and elbow surgeons, this volume is the most comprehensive, current reference on shoulder and elbow arthroplasty. Olecranon osteotomy for exposure of fractures and nonunions of.
Olecranon osteotomy for exposure of fractures and nonunions. Strip the softtissue attachments off the mediolateral sides retract it proximally elevating the triceps posterior aspect of the distal end of the humerus is directly. Outcome of olecranon osteotomy in the transolecranon approach of intra articular fractures of the distal humerus cilt vol. Morrey introduction few joints require familiarity with as many surgical exposures as does the elbow. A successful functional outcome after olecranon fractures correlates directly with accuracy of anatomic joint reduction, restoration of mechanical stability that allows early motion, respect for the soft tissue. Indications for the different techniques are clearly explained, and practical aspects that allow safe and reproducible clinical outcomes are described. Be safe stay in the care of responsible adult the first 24 hours. It was quite difficult to dissect it and to get the perspective right. Surgical treatment of intraarticular distal humeral fractures in adults. Tricepssparing extraarticular stepcut olecranon osteotomy.
The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra. Flex the elbow 90 degrees, reduce the fracture, and apply the plate. This chapter provides an overview of the surgical anatomy of the elbow. Outcomes following distal humeral fracture fixation with an extensor mechanismon approach jason m. Suture repair of simple transverse olecranon fractures and c. A surgical video demonstating technique of olecranon osteotomy for a distal humerus fracture. An olecranon osteotomy provides a trap door through. There is no consensus about the ideal surgical approach for orif of. The technique described in this report is technically straightforward and has a shorter learning curve than the chevron osteotomy.
A straight posterior incision is made longitudinally from approximately 8 cm proximal to the tip of the olecranon and 8 cm. Clinical results of the refixation of a chevron olecranon. Olecranon osteotomy end cap countersunk end cap for reduced soft tissue irritation and reoperations easy reattachment of olecranon single size. Although an olecranon osteotomy provides excellent exposure for management of these fractures, a number of complications can occur after the creation and repair of the osteotomy including nonunion, malunion. This book provides cuttingedge information on surgical techniques for sports injuries of the elbow, highlighting key practical aspects. The associated functional limitations, including an inability to reach over the head or to push off, are substantial.