Open reduction and internal fixation of olecranon fractures

The treatment of the olecranon fracture has two purposes; the first is the anatomical reduction of the semilunar incisional articular surface, and the strong internal fixation for early exercise and recovery; secondly, the normal elbow strength of the triceps is restored. . The triceps are attached to the olecranon. The fracture displacement of the olecranon will definitely cause the triceps tendon of the fracture site and the rupture of the triceps muscles on both sides. If not repaired, it will affect the extension of the triceps. Elbow strength. The more obvious the fracture displacement, the more serious the impact. To achieve the above purpose, only open reduction and internal fixation. Therefore, in addition to the displacement of the olecranon fracture, the plaster can be fixed outside the extension position, and the displaced olecranon fracture should be treated with open reduction and internal fixation. If the olecranon avulsion fracture is not involved in the articular surface, the small bone mass should be removed to repair the triceps. Treatment of diseases: olecranon fracture Indication The treatment of the olecranon fracture has two purposes; the first is the anatomical reduction of the semilunar incisional articular surface, and the strong internal fixation for early exercise and recovery; secondly, the normal elbow strength of the triceps is restored. . The triceps are attached to the olecranon. The fracture displacement of the olecranon will definitely cause the triceps tendon of the fracture site and the rupture of the triceps muscles on both sides. If not repaired, it will affect the extension of the triceps. Elbow strength. The more obvious the fracture displacement, the more serious the impact. To achieve the above purpose, only open reduction and internal fixation. Therefore, in addition to the displacement of the olecranon fracture, the plaster can be fixed outside the extension position, and the displaced olecranon fracture should be treated with open reduction and internal fixation. If the olecranon avulsion fracture is not involved in the articular surface, the small bone mass should be removed to repair the triceps. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture site should be taken with positive lateral x-ray film to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take x-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure 1. Position: prone position, upper limb abduction; or supine position, upper limb placed on the chest. 2. Incision and exposure: The posterior incision of the elbow joint was used to cut the skin longitudinally from the fracture site, which was about 6 cm long. The displaced fracture end and its shallow torn fascia can be seen under the skin. Longitudinal incision of the fascia and periosteum to reveal the distal segment of the fracture. 3. Reset: first flex the elbow joint, separate the fracture end, reveal and explore the elbow joint cavity. Remove blood in the joint cavity, bones and fascia that are often sandwiched between the ends, then straighten the elbow joint, and clamp the proximal fracture block with a towel clamp to lower it, and then reset it with a towel clamp. . 4. Internal fixation: Generally, stainless steel wire is used for internal fixation. If the proximal fracture block is short, the tunnel can be drilled by hand with a hand drilled about 1 to 2 cm away from the fracture line. Then use a round needle to guide the stainless steel wire, close to the ulnar humeral margin of the ulnar olecranon for semi-circular suture, and then pass the wire through the tunnel in the distal segment of the fracture in an 8-shaped cross (the wire crosses the back of the fracture, fixed The effect is strong, which can directly prevent the posterior angulation of the fracture.) The steel wire can be tightened after the examination is well reset and there is no fascia sandwiched between the fracture ends. Remove the towel clamp and extend the elbow joint. If the reset is well fixed, the excess wire can be cut off, and the triceps aponeurosis can be sutured and the incision can be sutured. If the proximal section of the fracture is long, a tunnel can be drilled in the near and far sides of the fracture, and the wire is fixed in an 8-shape.