Double-plate osteosynthesis for proximal ulnar fractures
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Technical Note Obere Extremität https://doi.org/10.1007/s11678-020-00602-z Received: 4 June 2020 Accepted: 28 August 2020
Nadine Ott1 · Michael Hackl1 · William Geissler2 · Lars P. Müller1 1 2
Department of Trauma, Hand and Elbow Surgery, University Hospital of Cologne, Cologne, Germany Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, USA
© The Author(s) 2020
Double-plate osteosynthesis for proximal ulnar fractures
Video online The online version of this article (https://doi. org/10.1007/s11678-020-00602-z) contains the video “Doppelplatten-Osteosynthese zur Versorgung proximaler Ulnafrakturen”. You will find the video at the end of the article as “Supplementary material.” Video by courtesy of © www.fame-forum.de.
the anatomical plate design and the lateral and medial positioning, it not only allows for anchoring with angle-stable screw placement, but also for bicortical and orthogonal screw connection with respect to the pulling forces of the triceps brachii muscle [2, 5].
Surgical technique Background Olecranon fractures account for a significant part of all fractures in the area of the upper extremity in adults, with a frequency of approximately 10%. Osteosynthesis is the treatment of choice for proximal ulnar fractures in most cases. The goal of osteosynthesis is to restore the anatomical congruence of the elbow joint and the integrity of the extensor apparatus in order to achieve early functional, physiotherapeutic aftercare. Simple transverse fractures proximal to the olecranon midline can potentially be stabilized by tension-band osteosynthesis. However, if there are oblique fractures or the fracture gap exceeds the apex of the olecranon fossa (. Fig. 1), the tension band can no longer trigger sufficient compression and instead causes a redirection to shear forces. The result can be a shortening of the olecranon fork. Low-profile plates in combination with lag screws represent an excellent modality for achieving stable joint congruence, in more complex fractures in particular. In addition to the use of dorsal lowprofile plates, double-plate osteosynthesis in lateral and medial positioning is an established procedure in our hospital and offers several advantages. Thanks to
Preoperative preparation and positioning of the patient The instruments should be checked for completeness. In addition to the basic instruments for osteosynthesis, including pointed reduction forceps and 2.0-mm Kirschner wires, flat profile plate instruments (Medartis; APTUS Ellenbogen, Basel, Switzerland) are required. Our hospital prefers to perform the surgery with the patient in the prone position whereby the affected arm is suspended from a mini table and is flexed at 90° at the elbow joint. The use of an upper-arm tourniquet is optional. A single-shot antibiotic should already be administered at the start taking into consideration possible allergies.
Surgical steps The approach is made proximal to the olecranon tip, starting as a dorsal
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