title: Cannulated screw fixation of refractory olecranon stress fractures with and without associated injuries allows a return to baseball.
abstract: BACKGROUND
  An olecranon stress fracture is a rare injury associated with valgus extension overload in baseball players. No long-term outcomes studies have been published documenting the results of surgical fixation of olecranon stress fractures with or without concomitant injuries in baseball players.
  
  
  OBJECTIVE
  Open reduction and internal fixation (ORIF) of an olecranon stress fracture will reliably produce bony union and allow a successful return to the previous level of activity in competitive baseball players.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Twenty-five patients treated with ORIF for an olecranon stress fracture at least 2 years earlier (range, 2-10.14 years) were retrospectively contacted to complete a telephone survey; 18 of 25 (72%) patients responded. Data were collected to determine the return to play rate, level of arm pain, and overall arm function.
  
  
  RESULTS
  All 18 stress fractures went on to successful union; 17 of 18 (94%) athletes returned to baseball at or above their previous level. Average return to play time was 29 weeks. The numeric analog pain score was 0.2 at rest and 0.3 when throwing at the time of follow-up, at an average 6.2 years (range, 2.0-10.14 years) after surgery. The average score at follow-up on the disabilities of the arm, shoulder and hand outcome measure-shortened version (QuickDASH) was 4.1 (range, 0-27.3). Ten (56%) patients required 13 additional future surgeries on their throwing arm; 7 surgeries in 6 (33%) patients were not related to the index surgery. Six of 18 (33%) patients underwent hardware removal, with 2 (11%) for infection.
  
  
  CONCLUSIONS
  Open reduction and internal fixation of olecranon stress fractures in competitive baseball players has a high rate of success in returning players to or above their former level of play and allows for good elbow function at an average of 6.2 years postoperatively. However, these patients are at high risk for additional future surgeries on their throwing arm.
authors.affiliation: American Sports Medicine Institute, Birmingham, Alabama, USA. james_paci@yahoo.com
authors.forename: James M
authors.initials: JM
authors.lastname: Paci
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dugas
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Guy
authors.forename: E Lyle
authors.initials: EL
authors.lastname: Cain
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Fleisig
authors.forename: Candice
authors.initials: C
authors.lastname: Hurst
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Wilk
authors.forename: James R
authors.initials: JR
authors.lastname: Andrews
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000601:surgery*; D001484:Baseball / Q000293:injuries*; D001863:Bone Screws; D004551:Elbow Joint / Q000601:surgery*; D005593:Fracture Fixation, Internal; D015775:Fractures, Stress / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014458:Ulna Fractures / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries