Clinical results of the olecranon fracture treatment using intramedullary fixation
Background. Olecranon fractures are mostly found in young people of working age. The tension band wiring is a “gold standard” for the olecranon fractures fixation. The literature and our own experience describe around 18.5–45.6 % unsatisfactory results. The purpose of this study was to investigate the results of the olecranon fracture treatment by open reduction and interlocking screw fixation in comparison with tension band wiring. Materials and methods. Indications for the olecranon fractures interlocking screw fixation and patients inclusion in the study were fractures of the proximal forearm type 21A1, 21A3, 21B1, 21B3, 21C1 and distal shoulder fractures type 13B1, 13C2, 13C1, 13C2, 13C3 by Association for Osteosynthesis/Association for the Study of Internal Fixation after olecranon osteotomy approach. The study reviewed clinical results of olecranon fractures treatment after interlocking screw fixation (n = 34) compared with the results of tension band wiring (n = 35). Cases were evaluated in the period of 4 years (2011–2015). The patients’ condition and dynamics of limb function recovery was determined by the Mayo and DASH (The Disabilities of the Arm, Shoulder and Hand) score during 5 days till 6 months after surgery. Results. The pain analysis showed that in the main group, pain stabilization was registered in 2 months of observation (36.6 ± 1.3 points), and with a slight deterioration (by 1.8 ± 1.2 points) compared to the first month (38.4 ± 1.3 points) of observation. The difference between 1 and 2 months was not statistically significant (p = 0.962). In the control group, the activity comes at a time after the second month of observation. After 6 months, there were determined insignificant (p = 0.138) changes in the pain level as compared to the 2-month follow-up. At all stages of observation, the difference was statistically significant (p = 0.001). The analysis showed that the range of motion increase in the elbow in the control group of patients occurred gradually from 5 days (11.6 ± 0.9 points) to 2 months of observation (17.2 ± 0.4 points), and remained virtually unchanged in 6 months (17.6 ± 0.4 points). In the main group, the average score in 5 days (17.6 ± 0.4) was the same as in the control group in a period of 6 months, and statistically significant (p = 0.002) increased to 2 months of observation (19.1 ± 0 3 points). At all stages of observation, the results were statistically significantly better. The DASH score analysis found that in the period from 1 to 2 months of observation, patients of the main group had not statistically significant (t = 0.389; p = 0.700) changes of the joint functional capacity (from 3.53 ± 3.50 to 3.3 ± 2.7 points, respectively, the change is 0.3 ± 3.9 points). At the 6-month observation, the amount score is 0.8 ± 1.2, and the difference from the previous period is 2.5 ± 2.4 points, and the difference is statistically significant (t = 6.036; p = 0.001). In the control group, we have noted another functional recovery dyna-mics. Between the 1st (12.3 ± 8.9 points) and 2nd (10.9 ± 7.7 points) months of observation, the difference was 1.4 ± 3.1 points and was statistically significant (t = 2.634; p = 0.013). The difference is also statistically significant (t = 8.521; p = 0.001) at the observation period of 6 months (6.9 ± 7.1 points to 4.0 ± 2.8 points). It should be noted that the average score of the main group patients at 1-month observation was significantly better (3.5 ± 3.5) than average score in the control group at the 6-month observation (6.9 ± 7.1). According to the Mayo score, in the study group excellent results were achieved in 33 (97 %) cases, and 1 patient had a good result. In the control group, the excellent result was achieved in 16 (45 %) cases, good result — in 16 (45 %) patients, satisfactory — in 2 (7 %), and 1 (3 %) patient had unsatisfactory result. According to the DASH score, in the study group, the disability of the arm was reduced from 3.53 to 0.8 points. In the control group, these characteristics were from 12.3 to 6.9 points. The difference is statistically significant in all periods of observation. The results were statistically significant. Conclusion. According to the comparative study, we can conclude that the proposed method of olecranon fracture treatment ensures fragments stable fixation with compression and the possibility of early motion. The results showed statistically significantly better outcomes in the interlocking screw group in comparison with tension band technique. Clinical cases were presented.
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