title: The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures.
abstract: BACKGROUND
  In order to improve initial operative treatment of complex olecranon fractures 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 patients operated with diagnosis of complex olecranon fracture were identified in an 8-year-period from trauma unit files at two European Level 1 Trauma Centers. Retrospective review of all operative reports and radiographs/computer-tomography scans identified patients with concomitance of an intermediate fragment. The Patient-Rated Elbow Evaluation Score was calculated for 45 of 80 patients at a minimum of 8 months postoperatively (range 8-84 months).
  
  
  RESULTS
  29 patients were treated with stable internal fixation with figure-of-eight tension band wire fixation and 51 patients with posterior plate osteosynthesis with/without intramedullary screw. An intermediate fragment was seen in 52 patients. In 29 of these 52 patients, the intermediate fragment was described in operative report. 24 of these 29 patients were treated with posterior plate osteosynthesis, and 5 patients with figure-of-eight tension band wiring. Complications included superficial infection (2 patients), secondary dislocation (3 patients) and heterotopic ossifications (1 patient). Functional outcome demonstrated a total PREE score of 9 points on average in 45 of 80 patients.
  
  
  CONCLUSIONS
  An extraordinary amount of patients 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 fracture pattern including presence of an intermediate fragment is recommended.
authors.affiliation: Department of Trauma Surgery, Murnau Trauma Center, Germany. vonrueden@bgu-murnau.de
authors.forename: Christian
authors.initials: C
authors.lastname: von Rüden
authors.forename: Alexander
authors.initials: A
authors.lastname: Woltmann
authors.forename: Christian
authors.initials: C
authors.lastname: Hierholzer
authors.forename: Otmar
authors.initials: O
authors.lastname: Trentz
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D056740:Olecranon Process / Q000000981:diagnostic imaging* / Q000293:injuries*; D009999:Ossification, Heterotopic / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome