Olecranon fractures in children: treatment of a rare entity
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ORIGINAL ARTICLE
Olecranon fractures in children: treatment of a rare entity Miriam Kalbitz1 · Birte Weber1 · Ina Lackner1 · Meinrad Beer2 · Jochen Pressmar1 Received: 8 June 2020 / Accepted: 26 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Olecranon fractures are a rare entity in children. The classification and treatment strategies are still discussed controversially. Methods A retrospective chart review of all patients 4 mm of displacement of the articular surface. Evans defines a 2–4 mm displacement as a gray zone in which the choice for surgical or non-surgical treatment has to be individually considered depending on the biomechanical stability as assessed clinically by an experienced surgeon [4]. In a recently published report two different approaches of treatment were compared: Open reduction with tension band wiring and closed reduction and percutaneous pinning. This study revealed percutaneous pinning as alternative to the gold-standard of tension band wiring [17] because no differences in the number of revision surgeries were found. Gicquel et al. [18] analyzed biomechanically olecranon fracture fixation technique in children. The standard method of Kirschner wire (1.8 mm) fixation with tension band wiring (1 mm) was compared to threaded pin stabilization (1.8 mm, anchored in the opposite bone cortex, compression achieved by an adjustable lock) and to simple pin fixation
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(1.8 mm smooth pin fitted with an olive) in cadaver ulnas with oblique fracture. No significant differences were found between the two first techniques while the simple pin fixation revealed much poorer mechanical properties [18]. Murphy et al. [19] compared four different fixation techniques of the olecranon in adults and found a superiority of tension band fixation, if combined with pins or with screws in comparison to isolated tension band fixation or an isolated intramedullary screw system. In a case series, resorbable sutures were used in children with olecranon fractures. Radiographic results were reported to be good without a loss of reduction [21]. Screw fixation technique is thought to be contraindicated in children because of the implant size and the consecutive damage of the growth plate. Using a threaded pin with adjustable lock placed in divergent directions has been suggested as an alternative to tension band fixation due to the minimal surgical approach and comparable compression at the fracture site [19]. In healthy children, the risk of refracture after hardware removal is minimal but children with osteogenesis imperfecta face a high risk (70%) of refracture or bilateral fracture [5]. The diagnosis of osteogenesis imperfecta should be considered in children with displaced apophyseal fractures of the olecranon. However, the classification and the subsequent treatment strategy of olecranon fractures in children is still discussed controversially. Therefore, this study correlates the fracture type and treatment strategy in a large collective of
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