Olecranon Fractures

Author: Mark Karadsheh

Topic updated on 04/12/13 3:25pm

Introduction

Epidemiology
- bimodal distribution
  - high energy injuries in young
  - secondary to falls in the elderly
Mechanism
- direct blow
  - usually results in comminuted fracture
- indirect blow
  - fall onto outstretched upper extremity
    - usually results in transverse or oblique fracture

Anatomy

Osteology
- together with coronoid process, forms the greater sigmoid (semilunar) notch
- greater sigmoid notch articulates with trochlea
  - provides flexion-extension movement
  - adds to stability of elbow joint
Muscles
- triceps
  - inserts onto posterior, proximal ulna
  - blends with periosteum
- anconeus
  - inserts on lateral aspect of olecranon

Classification

Mayo Classification
Based on comminution, displacement, fracture-dislocation

Colton Classification
Nondisplaced - Displacement does not increase with elbow flexion
Avulsion (displaced)
Oblique and Transverse (displaced)
Comminuted (displaced)
Fracture dislocation

Schatzker Classification
Type A	Simple transverse fracture
Type B	Transverse impacted fracture
Type C	Oblique fracture
Type D	Comminuted fracture
Type E	More distal fracture, extra-articular
Type F	Fracture-dislocation

AO Classifiation
Type A	Extra-articular
Type B	Intra-articular
Type C	Intra-articular fractures of both the radial head and olecranon

Presentation

Symptoms
- pain well localized to posterior elbow
Exam
- palpable defect
  - indicates displaced fracture or severe comminution
- inability to extend elbow
  - indicates discontinuity of triceps (extensor) mechanism

Imaging

Radiographs
- recommended views
  - AP/lateral radiographs
    - true lateral essential for determination of fracture pattern
- additional views
  - radiocapitellar may be helpful for
    - radial head fracture
    - capitellar shear fracture
CT
- may be useful for preoperative planning in comminuted fractures

Treatment

Nonoperative
- immobilization
  - indications
    - nondisplaced fractures
    - displaced fracture is low demand, elderly individuals
Operative
- tension band technique
  - indications
    - transverse fracture with no comminution
  - outcomes
    - excellent results with appropriate indications
- intramedullary fixation
  - indications
    - transverse fracture with no comminution (same as tension band technique)
- plate and screw fixation
  - indications
    - comminuted fractures
    - Monteggia fractures
    - fracture-dislocations
    - oblique fractures that extend distal to coronoid
- excision and triceps advancement
  - indications
    - elderly patients with osteoporotic bone
    - fracture must involve <50% of joint surface
    - nonunions
  - outcomes
    - salvage procedure that leads to decreased extension strength
    - may result in instability if ligamentous injury is not diagnosed before operation

Surgical Techniques

Non-operative management
- technique
  - immobilization in 45-90 degrees of flexion for 3 weeks
  - begin motion at 3 weeks
Tension band technique
- technique
  - converts distraction force of triceps into a compressive force
  - engaging anterior cortex of ulna with Kirschner wires may prevent wire migration
  - avoid overpenetration of wires through anterior cortex
    - may injury anterior interosseous nerve (AIN)
    - may lead to decreased forearm rotation
  - use 18-gauge wire in figure-of-eight fashion through drill holes in ulna
- cons
  - high % of second surgeries for hardware removal (40-80%)
  - does not provide axial stability in comminuted fractures
Intramedullary fixation
- technique
  - can be combined with tension banding
  - intramedullary screw must engage distal intramedullary canal
Plate and screw fixation
- technique
  - place plate on dorsal (tension) side
  - oblique fractures benefit from lag screws in addition to plate fixation
  - one-third tubular plates may not provide sufficient strength in comminuted fractures
  - may advance distal triceps tendon over plate to avoid hardware prominence
- pros
  - more stable than tension band technique
- cons
  - 20% need second surgery for plate removal
Excision and triceps advancement
- technique
  - triceps tendon reattached with nonabsorbable sutures passed through drill holes in proximal ulna

Complications

Symptomatic hardware
- most frequent reported complication
Stiffness
- occurs in ~50% of patients
- usually doesn't alter functional capabilities
Heterotopic ossification
- more common with associated head injury
Posttraumatic arthritis
Nonunion
- rare
Ulnar nerve symptoms
Anterior interosseous nerve injury
Loss of extension strength

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Qbank (10 Questions)

TAG

(OBQ11.114) An 82-year-old nursing home resident falls out of his motorized wheelchair onto a flexed elbow. He has pain at the elbow, no gross instability, and is unable to extend his elbow against gravity. His radiographs show an osteoporotic, comminuted displaced olecranon fracture involving 20% of the articular surface. Which of the following treatment options has the greatest likelihood of a functional elbow outcome? Topic

Review Topic

1. Cast immobilization in 90 degrees of flexion
2. Closed reduction and percutaneous pinning
3. ORIF with a tension band construct
4. ORIF with a locking plate
5. Fragment excision and triceps advancement

PREFERRED RESPONSE ▶

DISCUSSION: The patient in the scenario is a low-demand, osteoporotic, elderly patient with a comminuted olecranon fracture. The treatment of choice in this subset of patients with this fracture pattern is fragment excision and triceps advancement.

Hak et al reviewed the treatment of olecranon fractures, recommending ORIF for displaced intra-articular fractures, either via tension band wiring or plate osteosynthesis based on fracture pattern and associated ligamentous disruption. For elderly, low-demand, osteoporotic patients, triceps advancement and fragment excision is advocated in the case of severely comminuted, osteoporotic patients with a fracture involving <50% of the joint surface.

The reference by Morrey is a comprehensive review of fractures and fracture-dislocations about the elbow.

Incorrect answers:
Answer 1: Cast immobilization in 45-90 degrees of flexion is advocated for non-displaced fractures.
Answer 2: Not the treatment in cases of severe comminution and osteoporosis.
Answer 3: Not the treatment in cases of severe comminution and osteoporosis.
Answer 4: Not the best option for a low-demand patient with severe comminution and minimal joint surface involvement.

REFERENCES:

1. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)

2. Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175-85. PMID:7797857 (Link to Abstract)

Question Authors:

Terrill Julien MD, Ben Taylor MD, Jan Szatkowski MD,

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TAG

(OBQ11.141) Bridge plating of the olecranon is MOST appropriate in which of the following clinical scenarios? Topic

Review Topic

1. Fixation of an olecranon osteotomy used for distal humerus surgery in a 24-year-old male
2. Simple transverse olecranon fracture in 33-year-old female
3. Comminuted olecranon fracture in 45-year-old male
4. Severely comminuted proximal olecranon fracture in an osteoporotic 91-year-old female
5. Aphophyseal elbow fracture in 6-year-old male

PREFERRED RESPONSE ▶

DISCUSSION: Bridge plating is most appropriately used for fixation of comminuted fractures which are not able to be fixed anatomically. Of the choices listed above, this would be most appropriate in a comminuted fracture in a 45-year-old male. In contrast, literature shows that severely comminuted, osteoporotic low-demand elderly are best treated with olecranon fracture excision and triceps advancement when possible.

Bailey et al looked at the outcome of plate fixation of olecranon fractures. They concluded that plate fixation is effective for displaced olecranon fractures and leads to good functional outcome. There were low incidence of complications, although 20% did have removal of hardware due to irritation.

Hak et al reviewed the fixation options for olecranon fractures. In their review, they state that comminuted olecranon fractures can be treated by limited-contact dynamic-compression plates. They also supported the use of supplemental bone graft to support comminuted depressed articular fragments. Fragment excision and triceps advancement is appropriate in selected cases in which open reduction seems unlikely to be successful, such as in osteoporotic elderly patients with severely comminuted fractures.

REFERENCES:

1. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001 Nov;15(8):542-8. PMID:11733669 (Link to Abstract)

2. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)

Question Authors:

David Abbasi MD, Ben Taylor MD, Dave Marcu MD, Edward Perez M.D.,

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TAG

(OBQ10.38) During surgical treatment of an olecranon fracture with a tension band construct as seen in Figure A, what nerve is at risk with over penetration of the proximal anterior cortex of the ulna with the Kirchner wire? Topic

Review Topic

FIGURES: A

1. Median nerve
2. Anterior interosseous nerve
3. Posterior interosseous nerve
4. Ulnar nerve
5. Radial nerve

PREFERRED RESPONSE ▶

DISCUSSION: An inability to flex the thumb interphalangeal joint or the index finger distal interphalangeal joint is indicative of an anterior interosseous nerve palsy/injury.

This has been reported with tension band fixation of olecranon fractures, especially with overpenetration of the anterior cortex of the proximal ulna by the Kirschner wire. Anterior interosseous nerve palsy can also be possible by overpenetration of drill bits or screws through the anterior cortex. Initial treatment of this nerve injury is observation.

The referenced article by Parker et al reports a case of anterior interosseous nerve palsy after such tension band fixation. They note that this was a direct injury from the Kirchner wires.

The referenced article by Adams et al reviews nerve injuries about the elbow. They note that an appreciation of the complex anatomy of the region and an understanding of treatment options are necessary for surgeons who treat elbow injuries.

Figure A is a lateral radiograph of a olecranon fracture fixed with a tension band construct.

Incorrect Answers: The other nerves are not associated with overpenetration of the far cortex in an olecranon tension band fixation.

REFERENCES:

1. Parker JR, Conroy J, Campbell DA. Anterior interosseus nerve injury following tension band wiring of the olecranon. Injury. 2005 Oct;36(10):1252-3. PMID:16214467 (Link to Abstract)

2. Adams JE, Steinmann SP. Nerve injuries about the elbow. J Hand Surg Am. 2006 Feb;31(2):303-13 PMID:16473695 (Link to Abstract)

Question Authors:

Ben Taylor MD, Patrick McCulloch MD, Michael Hughes MD,

Please Rate Educational Value!

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TAG

(OBQ10.107) There is a risk of impaired forearm rotation after tension band fixation of an olecranon fracture with which of the following? Topic

Review Topic

1. Ipsilateral proximal humerus fracture
2. Protrusion of Kirschner wire fixation through the volar cortex of the proximal ulna
3. Use of ulnar intramedullary Kirschner wire fixation
4. Olecranon fracture comminution
5. Lack of triceps tendon repair

PREFERRED RESPONSE ▶

DISCUSSION: Impaired pronation/supination can be seen if the K-wire is advanced either too radial or too far through the volar (anterior) cortex of the proximal ulna. The anterior interosseous nerve is also at risk with overpenetration. Conversely, migration and loosening of the K-wire is reduced with involvement of the anterior cortex.

The referenced study by Candal-Couto et al is a cadaveric study that found that K-wire insertion in less than 30 degrees in an ulnar direction led to impingement of the K-wire on the radial head/neck, biceps or supinator. They recommend placing these wires away from this danger zone in order to minimize rotation blocks.

The referenced study by Matthews et al is a case series of two patients who had limited forearm rotation after K-wire fixation. The etiology of limited rotation was found to be from direct overpenetration of the K-wire, which led to a mechanical block.

REFERENCES:

1. Candal-Couto JJ, Williams JR, Sanderson PL. Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures: evaluation of the transcortical K-wire technique. J Orthop Trauma. 2005 Aug;19(7):480-2 PMID:16056081 (Link to Abstract)

2. Matthews F, Trentz O, Jacob AL, Kikinis R, Jupiter JB, Messmer P. Protrusion of hardware impairs forearm rotation after olecranon fixation. A report of two cases. J Bone Joint Surg Am. 2007 Mar;89(3):638-42. PMID:17332114 (Link to Abstract)

3. Schmeling GJ, Maciolek LJ. Olecranon fractures: open reduction internal fixation. In: Wiss D, ed. Masters Techniques in Orthopaedic Surgery: Fractures, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:107-120.

Question Authors:

Ben Taylor MD, Jan Szatkowski MD,

Please Rate Educational Value!

3.0

Average 3.0 of 18 Ratings

TAG

(OBQ09.138) A 33-year-old male sustains a distal humerus fracture, and is treated with open reduction and internal fixation of the distal humerus with olecranon osteotomy. A postoperative radiograph is shown in Figure A; a new deficit of the anterior interosseous nerve is now noted in the recovery room. What deficit can be expected with this nerve injury? Topic

Review Topic

FIGURES: A

1. Inability to flex radiocarpal joint
2. Loss of sensation over palmar aspect of thumb
3. Loss of sensation over dorsal hand first webspace
4. Inability to abduct index finger
5. Inability to flex thumb interphalangeal joint

PREFERRED RESPONSE ▶

DISCUSSION: Injury to the anterior interosseous nerve can be seen with K-wires that penetrate significantly through the anterior cortex of the proximal ulna, such as mentioned above. Injury to the anterior interosseous nerve, a branch of the median nerve, would lead to loss of ability to flex the thumb IP joint (choice 5). The first referenced article by Mekhail et al reviewed the anterior (Henry) approach to the proximal radius and recommended for lateral plate placement for the proximal radius, to decrease iatrogenic neurovascular injury. The second referenced article by Parker et al reviewed the anatomy of the AIN and noted that injury to the AIN is possible through overpenetration of the anterior proximal ulnar cortex.

REFERENCES:

1. Mekhail AO, Ebrahaim NA, Jackson WT: Anatomic considerations for the anterior exposure of the proximal portion of the radius. J Hand Surg Am 1996;21:794-801 PMID:8891976 (Link to Abstract)

2. Parker JR, Conroy J, Campbell DA: Anterior interosseous nerve injury following tension band wiring of the olecranon. Injury 2005;36:1252-1253 PMID:16214467 (Link to Abstract)

Question Authors:

Ben Taylor MD,

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TAG

(OBQ09.192) A 19-year-old male sustains the isolated, closed injury seen in Figure A. He is subsequently treated as shown in Figure B. When utilizing this technique, what forces are generated at the articular surface? Topic

Review Topic

FIGURES: A

1. Neutralization
2. Torque
3. Two-point bending
4. Shear
5. Compression

PREFERRED RESPONSE ▶

DISCUSSION: Figure A and B show a simple transverse olecranon fracture appropriately treated with a tension-band construct. This construct converts distraction forces at the joint generated by the pull of the triceps into compression forces. The change of force into compression requires active motion of the elbow extensor mechanism.

REFERENCES:

1. Jupiter JB: AO Manual of Fracture Management: Hand and Wrist. Boston, MA, AO Publishing, 2006

2. Chandler RW: Principles of internal fixation, in Bucholz RW, Heckman JD (eds): Rockwood and Green’s Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 181-229

Question Authors:

Ben Taylor MD,

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TAG

(OBQ09.243) A 79-year-old woman with osteoporosis presents with a displaced, severely comminuted olecranon fracture involving the proximal 40%. Which of the following represents the most appropriate treatment? Topic

Review Topic

1. Intramedullary screw
2. Kirschner wire tension band
3. Total elbow arthroplasty
4. Fragment excision and triceps advancement
5. Hinged elbow brace with early active range-of-motion

PREFERRED RESPONSE ▶

DISCUSSION: Multiple treatments exist for olecranon fractures. Tension band construct (Illustration A) and intramedullary screw or k-wire placement are typically reserved for non-comminuted olecranon fractures, whereas plate and screw fixation (Illustration B) is used for comminuted fractures. Hak et al review olecranon fracture treatment and state that fragment excision and triceps advancement is most appropriate in elderly, osteoporotic patients with severely comminuted fractures involving the proximal 30-40% of the olecranon. Veillette et al state that when performing a triceps advancement for treatment of an olecranon fracture, between 50% and 70% of the olecranon articular surface can be excised without compromising elbow stability provided the coronoid and distal trochlea are preserved.

When excision and triceps advancement is performed, the triceps should be attached adjacent to the articular surface.

Illustrations: A

REFERENCES:

1. Hak DJ, Golladay G Jr: Olecranon fractures: Treatment options. J Am Acad Orthop Surg 2000;8:266-275 PMID:10951115 (Link to Abstract)

2. Veillette CJ, Steinmann SP: Olecranon fractures. Orthop Clin North Am 2008;39:229-236 PMID:18374813 (Link to Abstract)

Question Authors:

Joshua Blomberg MD, Dave Marcu MD, Jan Szatkowski MD,

Please Rate Educational Value!

4.0

Average 4.0 of 6 Ratings

TAG

(OBQ07.204) A 24-year-old male sustains the isolated, closed injury seen in Figure A as the result of a fall. What surgical treatment is recommended for this fracture? Topic

Review Topic

FIGURES: A

1. Intramedullary nailing
2. Tension band with intramedullary screw
3. Triceps advancement
4. Plate and screw fixation
5. Total elbow arthroplasty

PREFERRED RESPONSE ▶

DISCUSSION: The radiograph shows a comminuted olecranon fracture with extension distally past the coronoid. Plate fixation is recommended for olecranon fractures with significant comminution and those that extend distal to the midpoint of the trochlear notch, which is present in this instance. The referenced article is an excellent review of olecranon fracture treatment options, including nonoperative treatment, tension band wiring, dorsal plating, and excision with triceps advancement.

REFERENCES:

1. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)

Question Authors:

Ben Taylor MD,

Please Rate Educational Value!

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Average 4.0 of 11 Ratings

TAG

(OBQ05.181) A 62-year-old man falls on his porch and sustains an elbow injury. A radiograph is provided in Figure A. Which of the following is the best treatment? Topic

Review Topic

FIGURES: A

1. Closed reduction and long arm casting
2. Early motion with a hinged elbow brace
3. Open reduction internal fixation with a tension band construct
4. Open reduction internal fixation with a plate
5. Fragment excision and advancement of the triceps tendon

PREFERRED RESPONSE ▶

DISCUSSION: The radiograph shows an olecranon fracture with articular comminution and depression of a large intra-articular fragment. This pattern is best treated with plate fixation to support the articular reduction.

Bailey et al reviewed 25 cases of olecranon fractures (simple and comminuted fracture patterns) treated with plate fixation. All 25 went on to union. There were no major complications reported. Twenty percent of patients underwent hardware removal at a later date for prominence.

Hak et al review the treatment options available for olecranon fractures. Simple intra-articular fractures without comminution are suitable for tension band fixation. Comminution of the articular surface is an indication for plate fixation and may benefit from bone graft to support depressed articular segments. Osteoporotic patients or fractures with severe comminution may do better with fragment excision and advancement of the triceps.

REFERENCES:

1. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation ofolecranon fractures. J Orthop Trauma. 2001 Nov;15(8):542-8. PMID:11733669 (Link to Abstract)

2. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)

Question Authors:

John Badylak MD, Ben Taylor MD, Michael Hughes MD,

Please Rate Educational Value!

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Videos

Olecranon fracture fixation with plate and screws

Trauma - Surgical Techniques - Olecranon Fractures

Example of internal fixation for a comminuted olecranon fracture.

12/17/2012

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Groups

ABOS II: Olecranon Fractures

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Evidence & References Show References

Level of Evidence 4 (Case Series)

Parker JR, Conroy J, Campbell DA. Anterior interosseus nerve injury following tension band wiring of the olecranon. Injury. 2005 Oct;36(10):1252-3. PMID:16214467 (Link to Abstract)
Matthews F, Trentz O, Jacob AL, Kikinis R, Jupiter JB, Messmer P. Protrusion of hardware impairs forearm rotation after olecranon fixation. A report of two cases. J Bone Joint Surg Am. 2007 Mar;89(3):638-42. PMID:17332114 (Link to Abstract)
Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation ofolecranon fractures. J Orthop Trauma. 2001 Nov;15(8):542-8. PMID:11733669 (Link to Abstract)

Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions, Personal Observations, and Biomechanic Studies)

Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)
Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175-85. PMID:7797857 (Link to Abstract)
Adams JE, Steinmann SP. Nerve injuries about the elbow. J Hand Surg Am. 2006 Feb;31(2):303-13 PMID:16473695 (Link to Abstract)
Hak DJ, Golladay G Jr: Olecranon fractures: Treatment options. J Am Acad Orthop Surg 2000;8:266-275 PMID:10951115 (Link to Abstract)
Veillette CJ, Steinmann SP: Olecranon fractures. Orthop Clin North Am 2008;39:229-236 PMID:18374813 (Link to Abstract)
Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Schmeling GJ, Maciolek LJ. Olecranon fractures: open reduction internal fixation. In: Wiss D, ed. Masters Techniques in Orthopaedic Surgery: Fractures, 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006:107-120.

Undefined

Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001 Nov;15(8):542-8. PMID:11733669 (Link to Abstract)
Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)
Candal-Couto JJ, Williams JR, Sanderson PL. Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures: evaluation of the transcortical K-wire technique. J Orthop Trauma. 2005 Aug;19(7):480-2 PMID:16056081 (Link to Abstract)
Mekhail AO, Ebrahaim NA, Jackson WT: Anatomic considerations for the anterior exposure of the proximal portion of the radius. J Hand Surg Am 1996;21:794-801 PMID:8891976 (Link to Abstract)
Parker JR, Conroy J, Campbell DA: Anterior interosseous nerve injury following tension band wiring of the olecranon. Injury 2005;36:1252-1253 PMID:16214467 (Link to Abstract)
Jupiter JB: AO Manual of Fracture Management: Hand and Wrist. Boston, MA, AO Publishing, 2006
Chandler RW: Principles of internal fixation, in Bucholz RW, Heckman JD (eds): Rockwood and Green’s Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 181-229
Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75. PMID:10951115 (Link to Abstract)
Macko D, Szabo RM. Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am. 1985 Dec;67(9):1396-401 PMID:3908460 (Link to Abstract)
Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res. 1992 Dec;(285):229-35. PMID:1446443 (Link to Abstract)

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Olecranon Fractures

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