Tan Bryan Yijia, Ng Jingwen, Ng Wei Xiang, Wei Yuan, Kwek Ernest Beng Kee
Department of Orthopaedic Surgery, Woodlands Health Campus, National Healthcare Group, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore.
Ministry of Health Holdings, Singapore, Singapore.
Indian J Orthop. 2022 May 17;56(8):1385-1393. doi: 10.1007/s43465-022-00646-z. eCollection 2022 Aug.
Olecranon fractures are a common fracture of the upper extremity. The primary aim was to investigate the evolution of olecranon fractures and fixation method over a period of 12 years. The secondary aim was to compare complication rates of Tension Band Wiring (TBW) and Plate Fixation (PF).
Retrospective Study for all patients with surgically treated olecranon fractures from 1 January 2005 to 31 December 2016 from a tertiary trauma center. Records review for demographic, injury characteristics, radiographic classification and configuration, implant choices and complications. Results grouped into three 4-year intervals, analyzed comparatively to establish significant trends over 12 years.
262 patients were identified. Demographically, increasing mean age (48.7 to 58.9 years old, value 0.004) and higher ASA scores (7.1% ASA 3 to 21.0% ASA 3 value 0.001). Later fractures were more oblique (fracture angle 86.1-100.0 degrees, value 0.001) and comminuted (Schatzker D type 10.4-30.0%, value 0.025, single fracture line 94.0-66.0%, value 0.001). Implant choice, sharp increase in PF compared to TBW (PF 16.0% to PF 80.2%, value 0.001). Complication-wise, TBW had higher rates of symptomatic implant, implant and bony failures and implant removal.
Demographic and fracture characteristic trends suggest that olecranon fractures are exhibiting fragility fracture characteristics (older age, higher ASA scores, more unstable, oblique and comminuted olecranon fractures). Having a high index of suspicion would alert surgeons to consider use of advanced imaging, utilize appropriate fixation techniques and manage the underlying osteoporosis for secondary fracture prevention. Despite this, trends suggest a potential overutilization of PF particularly for stable fracture patterns and the necessary precaution should be exercised.
尺骨鹰嘴骨折是上肢常见骨折。主要目的是研究12年间尺骨鹰嘴骨折的演变及固定方法。次要目的是比较张力带钢丝固定（TBW）和钢板固定（PF）的并发症发生率。
对2005年1月1日至2016年12月31日在一家三级创伤中心接受手术治疗的所有尺骨鹰嘴骨折患者进行回顾性研究。查阅记录中的人口统计学、损伤特征、影像学分类和形态、植入物选择及并发症情况。结果分为三个4年时间段，进行比较分析以确定12年间的显著趋势。
共确定262例患者。在人口统计学方面，平均年龄增加（从48.7岁至58.9岁，P值0.004）且美国麻醉医师协会（ASA）评分更高（ASA 3级从7.1%增至21.0%，P值0.001）。后期骨折更呈斜形（骨折角度86.1 - 100.0度，P值0.001）且粉碎性更强（Schatzker D型从10.4%至30.0%，P值0.025，单一骨折线从94.0%至66.0%，P值0.001）。植入物选择方面，与TBW相比，PF使用量急剧增加（PF从16.0%增至80.2%，P值0.001）。在并发症方面，TBW出现症状性植入物、植入物及骨质失败和植入物取出的发生率更高。
人口统计学和骨折特征趋势表明，尺骨鹰嘴骨折呈现出脆性骨折特征（年龄更大、ASA评分更高、更不稳定、斜形及粉碎性尺骨鹰嘴骨折）。保持高度怀疑指数会提醒外科医生考虑使用先进影像学检查、采用适当固定技术并处理潜在骨质疏松以预防二次骨折。尽管如此，趋势表明PF可能存在过度使用情况，尤其是对于稳定骨折类型，应采取必要的预防措施。
