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Cast immobilization
1%
10/1307
Intramedullary screw fixation
0%
4/1307
Open reduction and plate fixation
77%
1001/1307
Open reduction and internal fixation with tension band wiring
4%
54/1307
Fragment excision and triceps advancement
18%
233/1307
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The patient has an open comminuted transolecranon fracture-dislocation. This occurs when the distal humerus is driven through the proximal ulna, and it is often associated with comminution of the olecranon and proximal ulna. The distal fragment translates anteriorly. Results of surgical treatment of transolecranon fracture-dislocations are best and most reliable when the fracture is reduced anatomically and plate fixation is used. Nonsurgical management is not indicated in this injury pattern. Excision of the comminuted fragments and advancement of the triceps will likely lead to persistent anterior instability of the elbow. Tension band wiring relies on cortical contact which will not be possible in this fracture. Intramedullary screw fixation is also not possible because of the significant comminution.
3.9
(22)
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