However, the majority of fractures seen were intra-articular with a simple split into the trochlear notch with a variety of apophyseal avulsions (younger patients), and metaphyseal fractures (older patients) with varying amounts of displacement/step off.įive studies used recognized clinical outcome scores (Quick DASH, 9 Graves and Canale, 16 Mayo Elbow Performance Score (MEPS), 8 Gicquel). Caterini et al 15 used morphology and displacement, Gaddy et al 16 used displacement alone, Matthews 1 used a combination of displacement and associated injuries, Papavasiliou et al 17 used extra/intra-articular status, and Zionts and Moon 18 used morphology.ĭue to the wide variation in reporting of fracture type between studies it is not possible to formally aggregate the data. The other five studies designed their own classification systems. The Horne and Tanzer, and Mayo systems are based upon adult fractures. The Salter-Harris classification is a generic paediatric physeal classification system. The AO PCCF is a generic paediatric classification system based upon morphology. Bracq is a paediatric specific classification system describing the orientation of the fracture line (distal/oblique/parallel). 14 Of these, the Evans system is a comprehensive paediatric olecranon specific system based upon anatomic site, fracture configuration, intra-articular displacement, and associated injuries. Only 12 studies defined a classification system, of which seven used a previously published system (AO Paediatric Comprehensive Classification of Long-Bone Fractures (PCCF), 8, 9 Bracq, 10 Salter-Harris, 11 Horne and Tanzer, 12 Evans, 13 Mayo). Retrospective comparative study (OI patients) Retrospective comparative study (OI and non-OI patients) This systematic review aims to provide a concise update on the literature of isolated paediatric olecranon fractures, summarizing surgical indications, treatment options and expected outcomes. The long-term implications of an olecranon fracture involving the physis and surgical hardware such as wires potentially crossing the physis are also unclear. 5 Surgical indications in paediatric patients, however, are less clear, and often confusion arises as to the optimal surgical technique to employ in the growing skeleton across an open physis in this population. 3– 5 Those being treated operatively are typically treated with either tension band techniques, or plate fixation. The surgical indications in adult patients have been well studied, with only patients with truly undisplaced fractures (Mayo Type I), patients unfit for surgery, or elderly patients being treated non-operatively. 1 In adults, olecranon fractures are more common, representing 10% of all elbow fractures. Given the variability in fracture patterns, the complex anatomy, and associated injuries, treating surgeons must be familiar with multiple treatment methods and follow a systematic surgical strategy to avoid complications and achieve reliable outcomes.Olecranon fractures account for 4% of all paediatric elbow fractures, and are associated with other ipsilateral elbow injuries up to 20% of the time, which in turn are associated with poorer outcomes. In addition, fixation must be stable enough to permit early mobilization to avoid significant elbow stiffness. Because olecranon fractures are all intra-articular injuries, they require anatomic or essentially normal surface reduction and trochlear notch contour for predictable outcomes. The method of internal fixation is chosen based primarily on fracture type. Several treatment options for internal fixation have been described, including tension-band wiring, plate fixation, intramedullary screw fixation, and triceps advancement after fragment excision. Approximately 10% of fractures about the adult elbow consist of fractures of the olecranon process of the ulna and range from simple nondisplaced fractures to complex fracture-dislocations of the elbow.
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