A BIOMECHANICAL STUDY ON INTERNAL FIXATION OF PROXIMAL ULNA COMBINED WITH OLECRANON FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TENG Lin , ZHONG Gang , LIU Gang , XIAO Cong , LIU Guoming , HUANG Fuguo.

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.;

Corresponding author：

Keywords：

Proximal ulna fracture，Olecranon fracture，Kirschner wire and tension band wiring，Reconstruction plate，Olecranon anatomical plate，Biomechanical test

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Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.

Citation： TENG Lin,ZHONG Gang,LIU Gang,XIAO Cong,LIU Guoming,HUANG Fuguo.. A BIOMECHANICAL STUDY ON INTERNAL FIXATION OF PROXIMAL ULNA COMBINED WITH OLECRANON FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(1): 10-13. doi: Copy

1.	by dorsal plating. Oper Orthop Traumatol, 2009, 21(6): 571-585.
2.	Elbow Surg, 2000, 1(4): 247-255.
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6.	Gartsman GM, Sculco TP, Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg (Am), 1981, 63(5): 718-721.
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8.	Macintyre NR, IIyas AM, Jupiter JB. Treatment of forearm fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(1): 7-14.
9.	Zuelzer WA. Fixation of small but important bone fragments with a hook plate. J Bone Joint Surg (Am), 1951, 33-A(2): 430-436.
10.	肖裕华, 李建飞, 陈宗和, 等. 解剖钢板内固定治疗移位的尺骨鹰嘴骨折. 中国矫形外科杂志, 2008, 16(4): 310-312.
11.	Siebenlist S, Torsiglieri T, Kraus T, et al. Comminuted fractures of the proximal ulna—Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury, 2010, 41(12): 1306-1311.
12.	Simpson NS, Goodman LA, Jupiter JB. Contoured LCDC plating of the proximal ulna. Injury, 1996, 27(6): 411-417.
13.	Buijze GA, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
14.	童文卿, 王明海, 董有海. 尺骨鹰嘴解剖板治疗尺骨鹰嘴骨折. 中国临床医学, 2009, 16(3): 430-431.
15.	崔岩, 李延明, 孙绍彬. 锁定解剖钢板内固定治疗移位的尺骨鹰嘴骨折. 临床和实验医学杂志, 2010, 9(9): 708-709.
16.	滕林, 钟刚, 肖聪, 等. 重建钢板联合张力带治疗尺骨上段合并鹰嘴骨折. 中国修复重建外科杂志, 2011, 25(1): 17-20.
17.	Kloen P, Buijze GA. Treatment of proximal ulna and olecranon fractures.
18.	蒋协远, 王满宜, 黄强, 等. 尺骨鹰嘴骨折合并肘关节前脱位的手术治疗. 中华骨科杂志, 2000, 20(3): 154-156.
19.	King GJW. Plate fixation of fractures of the proximal ulna. Tech Shoulder.
20.	安维军, 马小民, 陈军, 等. 使用重建钢板手术治疗尺骨鹰嘴骨折. 宁夏医学杂志, 2005, 27(9): 605-606.
21.	Murphy DF, Greene WB, Dameron TB Jr. Displaced olecranon fractures.

1. by dorsal plating. Oper Orthop Traumatol, 2009, 21(6): 571-585.
2. Elbow Surg, 2000, 1(4): 247-255.
3. in adults. Clinical evaluation. Clin Orthop Relat Res, 1987, (224): 215-223.
4. Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am, 2008, 39(2): 229-236.
5. Chalidis BE, Sachinis NC, Samoladas EP, et al. Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res, 2008, 3: 9.
6. Gartsman GM, Sculco TP, Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg (Am), 1981, 63(5): 718-721.
7. 王岩, 译. 坎贝尔骨科手术学. 11版. 北京: 人民军医出版社, 2009: 2674.
8. Macintyre NR, IIyas AM, Jupiter JB. Treatment of forearm fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(1): 7-14.
9. Zuelzer WA. Fixation of small but important bone fragments with a hook plate. J Bone Joint Surg (Am), 1951, 33-A(2): 430-436.
10. 肖裕华, 李建飞, 陈宗和, 等. 解剖钢板内固定治疗移位的尺骨鹰嘴骨折. 中国矫形外科杂志, 2008, 16(4): 310-312.
11. Siebenlist S, Torsiglieri T, Kraus T, et al. Comminuted fractures of the proximal ulna—Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury, 2010, 41(12): 1306-1311.
12. Simpson NS, Goodman LA, Jupiter JB. Contoured LCDC plating of the proximal ulna. Injury, 1996, 27(6): 411-417.
13. Buijze GA, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted fractures. J Bone Joint Surg (Am), 2009, 91(10): 2416-2420.
14. 童文卿, 王明海, 董有海. 尺骨鹰嘴解剖板治疗尺骨鹰嘴骨折. 中国临床医学, 2009, 16(3): 430-431.
15. 崔岩, 李延明, 孙绍彬. 锁定解剖钢板内固定治疗移位的尺骨鹰嘴骨折. 临床和实验医学杂志, 2010, 9(9): 708-709.
16. 滕林, 钟刚, 肖聪, 等. 重建钢板联合张力带治疗尺骨上段合并鹰嘴骨折. 中国修复重建外科杂志, 2011, 25(1): 17-20.
17. Kloen P, Buijze GA. Treatment of proximal ulna and olecranon fractures.
18. 蒋协远, 王满宜, 黄强, 等. 尺骨鹰嘴骨折合并肘关节前脱位的手术治疗. 中华骨科杂志, 2000, 20(3): 154-156.
19. King GJW. Plate fixation of fractures of the proximal ulna. Tech Shoulder.
20. 安维军, 马小民, 陈军, 等. 使用重建钢板手术治疗尺骨鹰嘴骨折. 宁夏医学杂志, 2005, 27(9): 605-606.
21. Murphy DF, Greene WB, Dameron TB Jr. Displaced olecranon fractures.

Chinese Journal of Reparative and Reconstructive Surgery

A BIOMECHANICAL STUDY ON INTERNAL FIXATION OF PROXIMAL ULNA COMBINED WITH OLECRANON FRACTURE

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