Assessment of Intra-articular Screw Penetration During Radial Head and Olecranon Locking Plate Fixation

摘要

Fractures of the radial headeck and fractures of the olecranon are common injuries with incidences of around 2.8 and 1.15 per 10 000 person-years, respectively.16,18 Open reduction and internal fixation is currently the preferred method for treating certain types of olecranon fractures including those that are comminuted, distal to the midpoint of the trochlear notch, or involve the medial coronoid facet.5,6,11,12,15,26 Similarly, open reduction and internal fixation (ORIF) is a commonly used surgical technique for radial head fractures that are displaced and in 2 or 3 fracture parts.13,14,17,21,24Despite the increasing popularity of ORIF for these elbow fractures, the technique is not without potential complications. Previous studies have documented the anatomical variance of the proximal radius and ulna and have aimed at establishing guidelines to achieve proper osteosynthesis and avoid proximal radioulnar joint (PRUJ) impingement.10,23,28 Inadvertent intra-articular screw penetration can lead to early joint degeneration, pain, and loss of function.24 Lindenhovius et al evaluated 16 patients who underwent plate fixation for fractures of the radial head. Two patients experienced limited forearm rotation due to screws penetrating the PRUJ and underwent additional procedures to modify screw length.20 Similarly, a recent retrospective review of 18 patients who received ORIF for comminuted olecranon fractures reported that 2 patients required revision surgery for impingement.8Intraoperative radiographs and evaluation for crepitus are standard surgical practice for determining if screws violate the articular surface. The PRUJ and the ulnohumeral joint (UHJ) can be difficult to assess fluoroscopically and the accuracy of clinical exam to detect intra-articular screw penetration is unknown. Other reports have examined the reliability of these methods in a variety of joints other than the PRUJ and UHJ.1,3,4,29 The purpose of this study is to determine how reliable these methods are in instances when the PRUJ or UHJ may be penetrated during ORIF of the olecranon or radial head.