Olecranon fractures in children: Part 1: a clinical review; Part 2: a new classification and management algorithm.
Part 1: A Clinical Review: Fractures of the olecranon in children are uncommon, and the outcome has historically been reported as good. Management varies from simple immobilization to include various methods of internal fixation. Recently a new technique of fracture fixation has been used in an attempt to improve the management of this fracture. This article reviews olecranon fractures seen at two children's hospitals over a 10-year period. The purpose of the study was to review and classify various fracture patterns, different fixation techniques, and to assess medium-term outcomes after this uncommon injury. Part 2: A New Classification and Management Algorithm: A new classification system and management algorithm for fractures of the olecranon in children is presented. This was developed after a 10-year review of olecranon fractures and their management at two children's hospitals (Part 1). Minimally displaced or undisplaced fractures account for 80% of all olecranon fractures, and these are managed with immobilization, rarely requiring hospital admission. Of those fractures admitted to hospital, oblique metaphyseal fractures are most commonly seen and are satisfactorily treated with tension-band techniques, but a wide variety of fracture patterns are less common and may require different management. Previous classifications of this uncommon fracture have not addressed all of the significant features to categorize the fracture accurately or to imply a management pathway. This new anatomically based classification system facilitates accurate classification for research purposes, and its principles are applied in the clinical-management algorithm presented here.
Evans
M C
MC
The Royal Children's Hospital, Melbourne, Australia.
Graham
H K
HK
D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D004550:Elbow / Q000000981:diagnostic imaging; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D000092464:Elbow Injuries