N°280 - January 2019
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How I treat olecranon fractures
By Dominique M. Rouleau in category FOLLOW-UP
Université de Montréal - Hôpital du Sacré-Cœur de Montréal Québec, Canada
Olecranon fractures are among the most commonly operated on fractures in the upper limb. There are several fixation methods; here we will discuss tension-band wiring and plate fixation. Tension-band wiring is a classic fracture treatment method which is most commonly used in cases of olecranon fractures.1
The AO theoretical principles2 state that a curved, tubular structure under compression force has a tension side and a compression side.3 Therefore, according to the AO, when tensile force is applied to the tension side, the compression force increases on the opposite side. In keeping with this principle established 40 years ago, a simple fracture with no bone loss or fragmentation must be opposite the tension side. Plate fixation is used specifically in situations where this is not the case.
The olecranon cannot really be described as a curved, tubular bone under compression force, and some studies have shown that the compression force created by tension-band wiring on the olecranon is low.4 Brink et al. reported that compression force is only present in active extension.5 Indeed, numerous force vectors are applied to the first 8cm of the olecranon. The geometrical shape of the bone is also complex. The proximal ulna dorsal angulation, commonly called PUDA...
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