ORIF Olecranon -

Aim

to obtain anatomical reduction & rigid fixation to prevent residual articular irregularity, & allow early mobilisation.

Type	Description
1	proximal 1/3 of artic. surface
2	middle 1/3
3	distal 1/3 (± anterior dislocation radial head)

Alternatives
- non-operative treatment
- excision of proximal fragment
  - (can excise up to 80% of olecranon without affecting stability of elbow. But, causes less efficient extension, & must transpose ulnar nerve).

Xray

if unsure of degree of comminution, or associated. fractures (radial head, coronoid)

Consent including

post-traumatic arthritis, infection, non-union, painful metalware, ulnar nerve palsy

Position

Options

K wires & TBW (minimal comminution)

Make incision along lateral border of posterior ulna from 2.5 cm proximal to olecranon, to 7.5 cm distally
Expose fracture, debride & reduce
Hold with reduction forceps
Drill a transverse hole in distal fragment
Pass 2 x 1.6 mm K wires through olecranon into I.M. canal (some authors advocate penetrating anterior cortex distal to coranoid)
Pass 18 gauge wire through distal hole & proximal to wire ends (under triceps aponeurosis) in figure 8 (may use figure 8 suture in children)
Tighten both limbs
Bend K wire ends 180° & tap in to proximal. fragment (cut slits in triceps, & repair over top)
Close subcut. & skin

6.5 mm screw & TBW

After reduction, drill & insert 10-12.5 cm screw (useful if associated. ulnar diaphyseal fracture). Do not over tighten as incr. pressure on trochlea. Can use washer to assist in holding TBW loop proximally

Comminution options

Excise comminuted segment with careful osteotomies to reconstitute smooth trochlear curve. Then fix with wires or screw
Hand / Pre contoured plate (semitubular or LC-DCP) ± bone graft. Plate may be placed medial or lateral to reduce prominence, but less sound fixation especially in osteopenic bone

General local

Specific