Session V - Post Traumatic Reconstruction

Fracture and Nonunion of the Olecranon in Total Elbow Arthroplasty for Traumatic and Posttraumatic Conditions

Michael D. McKee MD, FRCSC; Stephen H. Gallay, MD, FRCSC, University of Toronto, Toronto, ON, Canada and Shawn W. O'Driscoll, MD, PhD; Guido Marra MD; Bernard F. Morrey MD, Mayo Clinic, Rochester, MN

Purpose: Discontinuity of the olecranon presents a unique challenge in the setting of semi-constrained total elbow arthroplasty for traumatic and posttraumatic conditions. The purpose of this study was to report the treatment methods and outcome characteristics of a consecutive series of patients who presented with this complex problem.

Methods: Twenty-four patients underwent 25 semi-constrained total elbow arthroplasties with discontinuity of the olecranon through previous fracture or established nonunion. The olecranon was addressed by tension-band wire fixation in 19, suture fixation in 2, and excision in 4.

Results: Overall, results were good, with an increase in the Mayo Elbow Performance (MEP) score from a mean of 40 preoperatively to a mean of 85 postoperatively (P = 0.0001). Range of motion increased from 80° to 106° (P = 0.04). Only 7 of the 21 elbows in which an attempt at union of the olecranon was made achieved union after the initial procedure, and 2 more achieved union after a second procedure. However, there were no differences in MEP score (86 versus 85) or range of motion (108° versus 104°) between the groups with bony union of the olecranon versus fibrous union or excision.

Discussion and Conclusion: When total elbow arthroplasty is performed in the presence of olecranon discontinuity, an attempt at fixation should be made. However, if adequate fixation cannot be achieved, fragment excision and triceps advancement and acceptance of a stable fibrous union are reasonable alternatives. A stable fibrous union or olecranon excision with soft tissue repair provides good elbow function and similar results after total elbow arthroplasty.