RESUMO
PURPOSE: To report radiologic, functional outcomes, and complications with a long-term follow-up in acute olecranon fractures treated with osteosynthesis and, secondly, to determine the predisposing factors to arthritis. METHODS: Forty-two patients treated with osteosynthesis for acute olecranon fractures were reviewed, with a minimum follow-up of 24 months. Radiological and clinical evaluations including DASH, MEPS, active range of motion, pain, arthritis, associated lesions, and complications were recorded. Arthritis was classified according to Broberg-Morrey scale. A logistic regression model was estimated to determine risk factors to develop ulnohumeral arthritis. The association between the types of fractures according to Mayo classification and MEPS, and the association between the type of fracture and the presence of pain were analyzed. RESULTS: The average follow-up was of 43.64 months. The flexion-extension average range was 135.6°, and the mean MEPS was 89.45; the DASH was 25.26. Eighteen cases (42.86%) were fixed with pre-contoured locking plates, 21 with tension band wiring (50%), and 3 with cannulated screws of 7 mm (7.14%). Six cases (14.29%) needed hardware removal. All fractures healed. Ulnohumeral osteoarthritis was observed in 14 cases (33.3%). We did not find a significant association among the MEPS, pain, and the fracture type, according to Mayo (p > 0.1 for both values). A significant association was found (p < 0.05) between fracture type and the osteoarthritis. CONCLUSIONS: In olecranon fractures, good functional and radiological results with low complications are predictable. The osteoarthritis is possible in more complex fractures and with other associated fractures.
Assuntos
Articulação do Cotovelo , Olécrano , Osteoartrite , Fraturas da Ulna , Placas Ósseas , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas , Humanos , Olécrano/diagnóstico por imagem , Olécrano/cirurgia , Osteoartrite/epidemiologia , Osteoartrite/etiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/epidemiologia , Fraturas da Ulna/cirurgiaRESUMO
Background: Acute management of fractures of the distal ulna that are associated with fractures of the distal radius remains difficult, particularly in the elderly. Methods: In this study, we investigated whether internal fixation of the distal ulna is associated with a higher rate of complications than resection of the distal ulna in patients older than 70 years. Twenty-four consecutive patients were included in this study, 12 of whom had undergone open reduction and internal fixation (ORIF) of the distal ulna, and 12 who had undergone distal ulna resection. Patients were retrospectively assessed for range of motion, grip strength, pain, and radiographic appearance. The functional outcome was evaluated by the Mayo Wrist Score. Complications were classified according to the Classification of Surgical Complications. Results: There were no differences in patient demographics between the 2 groups, except patient age. Clinical evaluation showed no difference at follow-up; however, there were significantly more complications associated with ORIF compared with resection. Conclusions: The results from our study show that women older than 70 years with fracture of the distal radius and distal ulna have a higher rate of complications if ORIF of the distal ulna is performed. Patients should be warned, by surgeons, of this in cases where ORIF of the distal ulna is suggested.
Assuntos
Fixação Interna de Fraturas/efeitos adversos , Redução Aberta/efeitos adversos , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Redução Aberta/métodos , Medição da Dor/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ulna/fisiopatologia , Ulna/cirurgia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/epidemiologiaRESUMO
Las fracturas del olecranon han sido tratadas con una gran variedad de metodos incluyendo: el tratamiento de inmovilizacion con yeso, reseccion del olecranon, la reduccion abierta y fijacion con el tornillo de Leibach propuesta por De Palma y otros autores, hasta llegar a la reduccion abierta y osteosintesis dinamica propuesta por la AO, siendo esto ultimo lo realizado en el presente trabajo en 34 pacientes desde 1979, en el Hospital San Ignacio de la Universidad Javeriana. El objetivo principal fue analizar los resultados funcionales del tratamiento de las fracturas del olecranon utilizando el metodo de la osteosintesis dinamica. Los objetivos secundarios fueron: analizar mecanicamente la tecnica y comparar los resultados obtenidos con otros sistemas de tratamiento. Se analizaron los siguientes parametros el pre y postoperatorio; edad, sexo, tiempo transcurrido entre el accidente y la cirugia, tipo de la fractura, seguimiento, movilidad del codo, dolor, tiempo de inmovilizacion, tiempo de consolidacion, estabilidad, fallas tecnicas y complicaciones. En los 34 pacientes obtuvimos resultados funcionales excelentes, por lo tanto creemos que el metodo de la osteosintesis dinamica es el ideal para el tratamiento de las fracturas del olecranon, obteniendo "una movilidad del codo".