Intramedullary locking compression nail for the treatment of an olecranon fracture

Abstract

Objective: Reconstruction of the anatomy of the olecranon, while protecting the soft tissue, by an internal stabilization method that is stable under exertion.

Indications: All olecranon fractures.

Contraindications: Very small (< 5 mm) proximal fragments at the point of nail entry. Bony avulsions of the triceps tendon.

Surgical technique: In the case of displaced olecranon fractures, exposure of the ulnar nerve, open reduction, fracture retention with reduction forceps, introduction of a 1.6 or 2.0 mm thick central guide wire into the medullary cavity in a slightly radial direction, overdrilling with a 3.5- or 4.5-mm cannulated drill bit, introduction of the nail to the aiming arm, and locking with 2.0-mm threaded wires. If the fracture pattern is transverse or slightly oblique, axial compression can be achieved by insertion of a compression screw into the nail. Fragments from the posterior margin or medial/lateral comminuted zones can be fixed more securely to the system via fiber cerclage wires around the threaded wires. After checking by X-ray, shortening of the threaded wires with the bolt cutters.

Postoperative management: Stable under exertion, splint-free postoperative management for 6 weeks, followed by full load bearing.

Results: From May 1999 to December 2002, 80 olecranon fractures were treated using the XS nail. 73 patients (91.3%) were followed up after an average of 15 months. 49 (67.1%) had a multifragmentary or comminuted fracture, and 24 (32.9%) a simple transverse fracture. According to the Murphy Score, results were excellent in 47 cases (64.4%), good in 21 (28.8%), satisfactory in three (4.1%), and poor in two (2.7%).