TENSION BAND WIRING OF OLECRANON FRACTURES

Indications

• Displaced transverse fractureof the olecranonwithdisruption of the extensor mechanism.

• The technique can be used with caution in oblique or fragmented fractures once issues related to these fracture patterns are addressed.

Pre-operative planning

Clinical assessment

• Mechanism of injury: forced extension usually following a fall. Beware of the high-energy fracture patterns that may suggest that the fracture is only a portion of the injury.

• Findings: pain, swelling and occasionally impressive ecchymosis over the elbow region. Beware of injury to the soft tissue envelope that may interfere or preclude surgical intervention.

• Findings: loss of active extension associated with displaced fractures. Beware of examination pitfall where passive gravity-assisted extension leads to the assumption of an intact extensor mechanism.

• Findings: check for ulnar nerve impairmentandensure the injury is in isolation.

Radiological assessment

• Anteroposterior and lateral radiographs of the elbow are the absolute minimum imaging requirement. Beware of more complex injuries that may need further imaging, most commonly in the formof a CT scan (Fig. 3.1).

Operative treatment

Anaesthesia

• Regional/general.

• Pre-operative administration of antibiotics (cephalosporin).

• Prescrub and drying of the limb.

• Tourniquet application, if there are no contraindications. Ensure the tourniquet does not interfere with the operative field and that no preparation solution leaks underneath. Inflate the tourniquet once the limb has been elevated for approximately 3 minutes.