Nijs S, Graeler H, Bellemans J
Dept. of Trauma Surgery, Clinic for Orthopaedic and Trauma Surgery, UZ Leuven, Herestraat 49, 3000, Leuven, Belgium.
Oper Orthop Traumatol. 2011 Dec;23(5):438-45. doi: 10.1007/s00064-011-0112-0.
Stable fixation of simple olecranon fractures or olecranon osteotomies in order to allow early functional treatment.
Simple (non-comminuted) olecranon fractures and (Chevron) osteotomies of the olecranon.
Comminuted fractures and fractures more than 40 mm distal than the tip of the olecranon are contraindications.
Using a slightly curved posterior approach, the fracture is anatomically reduced. The fracture is temporary stabilized using K-wires. A guiding K-wire is positioned centrally in the medullary canal in the lateral projection. The medullary canal is reamed over the K-wire. The distal part of the nail is inserted and locked. The proximal part is inserted and screwed onto the distal part to compress the fracture. For osteotomies, the distal part is inserted and locked (using the same technique as described before) prior to performing the osteotomy. At the end of the surgery, the osteotomy is reduced, the proximal part is inserted, and the osteotomy is compressed.
As the stability of this compressive osteosynthesis is very high, early post-operative mobilization is allowed. No immobilization is used. Depending on the soft tissue situation, active range of motion and passive stretching is initiated immediately postoperatively.
Using this technique in 21 patients (mean age 42 years) with acute fractures or osteotomies, sound fracture healing was achieved in 19 of 21 patients. The active range of motion was 130.2° flexion, 10.6° extension deficit, and a normal pro-supination arch. In one patient, delayed union caused implant failure. In this patient, a surgical error jeopardized stability. In a second patient, a peri-implant fracture after adequate trauma made a change in therapy necessary.
实现简单尺骨鹰嘴骨折或尺骨鹰嘴截骨的稳定固定，以便进行早期功能治疗。
简单（非粉碎性）尺骨鹰嘴骨折及尺骨鹰嘴（人字形）截骨。
粉碎性骨折以及骨折线位于尺骨鹰嘴尖端远侧超过40毫米的骨折为禁忌证。
采用略弯曲的后入路，将骨折进行解剖复位。用克氏针临时固定骨折。在侧位投照下，将一根引导克氏针置于髓腔内中央。沿克氏针对髓腔进行扩髓。插入髓内钉远端并锁定。插入近端并拧到远端以加压骨折部位。对于截骨术，在截骨术前插入并锁定远端（采用与上述相同技术）。手术结束时，使截骨复位，插入近端并对截骨部位加压。
由于这种加压接骨术的稳定性很高，允许术后早期活动。无需固定。根据软组织情况，术后立即开始主动活动范围练习和被动伸展。
对21例急性骨折或截骨患者（平均年龄42岁）采用该技术，21例中有19例骨折愈合良好。主动活动范围为屈曲130.2°，伸展受限10.6°，旋前 - 旋后弧度正常。1例患者出现骨折延迟愈合导致内植物失败。该患者因手术失误影响了稳定性。另1例患者在遭受适当创伤后发生内植物周围骨折，需要改变治疗方法。
