Displaced olecranon apophyseal fractures in children with osteogenesis imperfecta.

Three boys with mild osteogenesis imperfecta (OI) who sustained eight apophyseal avulsion fractures of the olecranon were compared with four normal boys with a unilateral apophyseal fracture. The children with OI were younger (11 years 7 months) than the normal children (14 years 3 months). All fractures were treated with tension band wiring (TBW). The contralateral elbow fractured 1 to 12 months later in the children with OI. Refractures occurred in two elbows, 6 to 16 months after the initial fracture and after TBW removal. One refracture presented late as a nonunion and was treated with bone grafting and plate fixation. None of the normal children experienced refracture after TBW removal. Good functional results and range of movement were achieved. Surgical treatment is recommended for all displaced fractures of the olecranon apophysis. There is a high risk of bilateral injury and a risk of refracture following removal of TBW in children with OI.