Wide-Awake Anesthesia for Olecranon Fracture Fixation.

Introduction: Wide-awake local anesthesia and no tourniquet (WALANT) has come a long way. It has been reported to be successful in the surgery of distal radius and ulna fractures. We report a case of olecranon fracture plating under WALANT. Methods: Surgery was performed with the patient fully conscious where tumescent anesthesia was injected into the surgical site without application of tourniquet 30 minutes before the first incision. Posterior approach to the elbow was used, and the fracture was fixed with anatomical locking plates. Results: The surgery was successfully completed without pain. The numerical pain rating score was 0 throughout the surgery. Conclusions: The use of WALANT for surgical fixation can be expanded beyond the hand and wrist. This is a safe and simple option for patients at high risk of general anesthesia, producing similar surgical outcomes without intraoperative and postoperative complications.

Biomechanical Assessment of Locking Plate Fixation of Comminuted Proximal Olecranon Fractures.

OBJECTIVES: To determine if mean ultimate strength or failure mechanism differed between comminuted olecranon fractures created at the proximal 25% or 50% of the trochlear notch and fixed with precontoured posterior locking plates (PLPs). METHODS: Comminuted osteotomies were created in 10 matched pairs of cadaveric upper extremities at either the proximal 25% or 50% of the trochlear notch after quantitative computed tomography scans were performed to evaluate bone mineral density. Variable-angle olecranon PLPs were fixed to the specimens. The triceps tendon of each specimen was loaded cyclically and then to failure. Comparison of mean force at failure (displacement >2 mm) was performed using the 2-tailed t test. RESULTS: There were no significant differences in specimen bone mineral density within matched pairs. Nineteen specimens failed by olecranon bisection fracture in the sagittal plane. Specimens in the 25% osteotomy group failed at lower ultimate forces of 808 N (SD ± 474 N) versus 1058 N (SD ± 480 N) in the 50% osteotomy group (P = 0.044). CONCLUSIONS: The ultimate strength of comminuted olecranon fracture fixation with a PLP decreases significantly if the fracture is proximal to the midpoint of the trochlear notch. Fractures proximal to the midpoint of the trochlear notch may benefit from supplemental fixation or suture augmentation to prevent failure, particularly at force ranges higher than those experienced during active elbow range of motion.

Nonoperative manipulative reduction with Chinese herbs for the treatment of a displaced olecranon fracture: A case report.

RATIONALE: Displaced olecranon fracture is a common injury following a fall or direct trauma to the elbow. There have been no reports of patients with a displaced olecranon fracture who have only received nonoperative manipulative reduction with Chinese herbs. PATIENT CONCERNS: The patient was a 64-year-old woman with a complex elbow injury that occurred in a traffic accident. The patient complained of severe, painful limitation of motion on straightening or bending. DIAGNOSES: The patient was diagnosed with a displaced fracture of the left olecranon (type IIA olecranon fracture according to the Mayo classification system). INTERVENTIONS: The patient underwent nonoperative manipulation with Chinese herbs. OUTCOMES: The fracture was successfully reduced. After 3 to 4 months of follow-up, severe pain and disability in the elbow were improved following reduction of the left olecranon fracture in which there was no longer a displacement. LESSONS: Nonoperative manipulative reduction performed by a well-trained physician with Chinese herbs may be a treatment option for displaced olecranon fractures.

Treatment of olecranon bursitis: a systematic review.

INTRODUCTION: The optimal management of olecranon bursitis is ill-defined. The purposes of this review were to systematically evaluate clinical outcomes for aseptic versus septic bursitis, compare surgical versus nonsurgical management, and examine the roles of corticosteroid injection and aspiration in aseptic bursitis. MATERIALS AND METHODS: The English-language literature was searched using PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Cochrane Central Register of Controlled Trials. Analyses were performed for clinical resolution and complications after treatment of aseptic and/or septic olecranon bursitis. RESULTS: Twenty-nine studies containing 1278 patients were included. Compared with septic bursitis, aseptic bursitis was associated with a significantly higher overall complication rate (p = 0.0108). Surgical management was less likely to clinically resolve septic or aseptic bursitis (p = 0.0476), and demonstrated higher rates of overall complications (p = 0.0117), persistent drainage (p = 0.0194), and bursal infection (p = 0.0060) than nonsurgical management. Corticosteroid injection for aseptic bursitis was associated with increased overall complications (p = 0.0458) and skin atrophy (p = 0.0261). Aspiration did not increase the risk of bursal infection for aseptic bursitis. CONCLUSIONS: Based primarily on level IV evidence, nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. The clinical course of aseptic bursitis appears to be more complicated than that of septic bursitis. Corticosteroid injection is associated with significant risks without improving the outcome of aseptic bursitis. LEVEL OF EVIDENCE: Therapeutic IV.

A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis.

Brucellosis is a systemic infection involving many organs and tissues. The musculoskeletal system is one of the most commonly affected. The disease can present with sacroiliitis, peripheral arthritis, spondylitis, paraspinal abscess, bursitis, and osteomyelitis. A 25-year-old male patient was admitted with fever of 20-day duration, right-sided hip pain, and night sweating. A Brucella standard tube agglutination test was positive at a titer of 1/160. Magnetic resonance imaging (MRI) of the hip joint showed right sacroiliitis and a hyperintense, nodular, lobulated mass within the right iliacus muscle, consistent with abscess. The patient was started on intramuscular streptomycin at a dose of 1 g/day, oral rifampin 600 mg/day, and doxycycline 200 mg/day. On day 20 of treatment, the patient was admitted with swelling and pain over the left elbow for the past week. MRI of the left elbow was performed, which showed fluid edema suggestive of olecranon bursitis. Taking the patient's complaints into consideration, rifampin and doxycycline treatment were maintained for a year. Pain at the hip joint and elbow resolved and MRI findings disappeared. Abscess of the iliacus muscle, which has not been reported before, and the olecranon bursitis that developed during treatment make this case worth presenting.

Nonunion of a Stress Fracture Through the Olecranon Epiphyseal Plate in an Adolescent Judo Player: A Case Report / 대한정형외과학회잡지

It was reported that many adverse effects occurred to the growth areas of the adolescent player due to repititous strain. The injuries mainly involved in the shoulder and elbow, and named as little leaguers Shoulder and Little Leaguers: Elbow in boy baseball player. But the stress fracture of olecranon epiphyseal plate was rare and reported in a few cases. We reported a case observed in an adolescent Judo Player.