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However, based on our experiences, we found that not all olecranon fractures with posterior dislocation were posterior Monteggia fractures. Also, almost all studies considered that olecranon fractures with posterior dislocation were a type of posterior Monteggia fracture (type Bado IIA), which is associated with disruption of the proximal radioulnar joint and possible injury of the lateral ulnar collateral ligament. This characteristic distinguishes it from the anterior Monteggia fractures in which the proximal radioulnar joint is disrupted. In 1974, Biga defined olecranon fractures with anterior dislocation as trans-olecranon fracture dislocation, and many scholars clearly pointed out that this injury is the result of fracture through the olecranon, while the proximal radioulnar joint remains stable. There are many articles about olecranon fractures with anterior dislocation. At present, it is considered that there are two kinds of such injuries: One is olecranon fractures with anterior dislocation, and the other is olecranon fractures with posterior dislocation. Studies of olecranon fracture dislocations of the elbow were rare due to its low incidence therefore, there is no uniform standard for the diagnosis, classification, and treatment. Olecranon fractures with elbow dislocation are rare, which can cause serious elbow instability. Correct understanding of this kind of injury and reasonable treatment plan can achieve good function. After bony structure is restored, the repairment of lateral collateral ligament complex is also important to the stability of the elbow joint. Trans-olecranon fracture posterior dislocation is a rare injury and has unique characteristics, and it is a kind of complex elbow instability involving the coronoid process and radial head fractures. The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 0.75 ± 1.2 points (0–3.3 points). The mean score according to the Broberg and Morrey functional rating index was 98.8 ± 2.5 points (92–100 points), nine patients were excellent, and another was good. Nine patients’ functional results according to the Mayo Elbow Performance Score (MEPS) were excellent with a mean score of 96.5 ± 5.3 points (85–100 points), and another was good. The motion of the elbow and functional outcome were evaluated with several methods. All patients underwent surgical management and were followed up on average for 15.8 ± 3.2 months (12–20 months). All patients suffered lateral collateral ligament complex injury. Eight patients (80%) suffered radial head fractures, seven fractures were type II, and one was type III. Nine patients (90%) suffered coronoid process fractures, eight fractures were type III, and one was type II. Eight patients (80%) were comminuted, and two were oblique olecranon fracture. ResultsĪ total of 309 patients were diagnosed olecranon fractures in our institution, and ten patients met the inclusion criteria, 9 males and 1 female, with an average age of 40.6 ± 12.7 years (26–68 years). We also made the inclusion criteria and exclusion criteria. Data on these patient demographics, injury characteristics, preoperative and postoperative imaging, surgical management, and outcomes were recorded and analyzed. We retrospectively analyzed all patients with olecranon fractures who were treated at our institution from January 2013 to April 2021. The aim of this study was to better define this kind of severe elbow instability, which has not been previously reported. Based on our experiences, we found that a kind of elbow injury is characterized by an olecranon fracture accompanied by elbow joint posterior dislocation with the proximal radioulnar joint intact. |
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