Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Abstract

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion-extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

Keywords: elbow; olecranon fracture; transolecranon fracture dislocations.

Figure 1

Preferred reporting items for systematic reviews.

Figure 2

A sixty-year-old man sustained a trans-olecranon fracture-dislocation of the left elbow due to a two-meter fall. (A) The initial lateral radiograph revealed a complex fracture pattern of olecranon and the forearm was dislocated anteriorly. (B) There were impacted articular fragments at the center of olecranon fossa. (C) Lateral radiograph taken two days after the operation demonstrates restoration of the normal ulnotrochlear relationship with a minimal bone defect of the bare area of olecranon. (D) A lateral radiograph taken ten months after the operation shows the union of fracture sites without any arthritic change. (E,F) A good functional result was achieved.