TRANSOLECRANON FRACTURE-DISLOCATION OF THE ELBOW

Objective: To characterize the prevalence, morphology, and prognosis o f anterior (transolecranon) fracture-dislocations of the elbow. Design : Retrospective case series. Setting: A consecutive series of thirteen patients from a single level-one trauma center, plus four patients fr om the practices of two of the senior authors. Patients: Three of seve nteen patients had simple, oblique fractures of the olecranon, and fou rteen had complex, comminuted fractures of the proximal ulna, includin g fragmentation of the olecranon in seven patients, large coronoid fra gments in eight patients, and segmental fractures of the ulna in six p atients. Fourteen patients were male and three were female, with an av erage age of thirty-eight years (range, 18 to 78 years). Intervention: All fractures were treated by open reduction and internal fixation. T wo one-third tubular plates had to be revised to 3.5-millimeter dynami c compression plates within six weeks of the initial operation. Main O utcome Measure: Elbow performance rating of Broberg and Morrey. Result s: At an average follow-up of twenty-five months, overall outcome was rated as excellent in seven patients, good in eight, and fair in two. Mild posttraumatic arthritis was noted in only two patients. Large cor onoid fragments and extensive comminution of the trochlear notch did n ot preclude a good result provided that stable, anatomic fixation was achieved. Conclusions: Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the p roximal ulna. This injury is frequently confused with anterior Montegg ia lesions by virtue of the readily apparent radiocapitellar dislocati on. Stable restoration of the appropriate contour and dimensions of th e trochlear notch of the ulna will lead to a good result in most cases .