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. 2022 Feb 1;36(2):e62-e66.
doi: 10.1097/BOT.0000000000002189.

Mitigation of Triceps Avulsion Fracture After Proximal Ulna Plate Fixation

Jorge Orbay  1 , Lauren Vernon  1 , Keegan Gibson  1   2 , Gustavo Lacau  1 , Deana Mercer  3 , Nathan Hoekzema  4
Affiliations

Mitigation of Triceps Avulsion Fracture After Proximal Ulna Plate Fixation

Jorge Orbay et al. J Orthop Trauma. .

Abstract

Objectives: Triceps avulsion fractures have become an increasingly common postoperative complication of olecranon fracture repair with proximal ulna plate (PUP) fixation. The purpose of this study is to create an efficient, reproducible mechanism to mitigate this issue.

Methods: Ten matched pair cadaveric specimens underwent a complete transverse osteotomy to simulate an olecranon fracture, followed by fracture reduction with a PUP. One arm from each pair underwent an additional augmented suture repair, where the triceps tendon was sutured directly to the plate. A custom jig was used to hold the specimen in position and apply a tensile force on the triceps until mechanical failure.

Results: All control specimens (without augmented suture repair) failed through a full-thickness triceps avulsion fracture at an average force of 967.7 N. The augmented suture-repaired specimens failed at an average force of 1204.3 N through partial avulsion fractures, widening of the osteotomy site, and triceps ruptures.

Conclusions: Our study demonstrated that an augmented suture repair of PUP fixation for olecranon fractures is a simple and effective way to significantly increase fixation strength and change the potential failure mechanism.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Biomechanical diagrams. A, Tension band attached to the tendon insertion (Sharpey fibers) unloads the proximal fragment and transfers the load to the distal fragment. B, PUP fixation, triceps force only resisted by screw pull-out strength. C, Olecranon screw pull-out strength is insufficient to withstand triceps forces and results in triceps avulsion fracture. D, Suture repair: Suture passed through the full thickness of the triceps down to the bone surface with purchase in the Sharpey fibers and back through the plate.
FIGURE 2.
FIGURE 2.
Custom jig used to stabilize the specimens for mechanical testing. A, The forearm is held with brackets in pronation and the elbow in flexion. The line of pull of the triceps is 60 degrees to the ulna and in line with the olecranon screws. B, A cryo-clamp was developed with dry ice–filled chambers to secure the triceps.
FIGURE 3.
FIGURE 3.
Results. Control specimens that failed through a full-thickness avulsion fracture.
See this image and copyright information in PMC

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