The pivotal role of the intermediate fragment in initial operative treatment of olecranon XXXX .

@entity1 @entity281 @entity130 @entity174
BACKGROUND: In order to improve initial operative treatment of complex olecranon @entity174 we searched for new determining details. We assumed that the intermediate fragment plays a decisive role for anatomic restoration of the trochlear notch and consecutive outcome of initial operative treatment. METHODS: 80 @entity1 operated with diagnosis of complex olecranon @entity174 were identified in an 8-year-period from trauma unit files at two European Level 1 @entity130 Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified @entity1 with concomitance of an intermediate fragment. The @entity1 -Rated Elbow Evaluation Score was calculated for 45 of 80 @entity1 at a minimum of 8 months postoperatively (range 8-84 months). RESULTS: 29 @entity1 were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 @entity1 with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 @entity1 . In 29 of these 52 @entity1 , the intermediate fragment was described in operative report. 24 of these 29 @entity1 were treated with posterior plate osteosynthesis, and 5 @entity1 with figure-of-eight tension band wiring. Complications included superficial @entity281 (2 @entity1 ), secondary dislocation (3 @entity1 ) and heterotopic ossifications (1 @entity1 ). Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 @entity1 . CONCLUSION: An extraordinary amount of @entity1 showed an intermediate fragment. Consideration, desimpaction and anatomic reduction of the intermediate fragment are necessary preconditions for anatomic restoration of the trochlear notch. There is no clear benefit for plating versus tension band wiring according to our data. In the operative report precise description of the @entity174 pattern including presence of an intermediate fragment is recommended.
