Herbert screw fixation may safely treat isolated olecranon fractures in children

Yang Li et al conducted a study to assess the clinical and radiological outcomes of closed reduction with percutaneous Herbert screw fixation in children with isolated olecranon fractures. They found that - Fixation of olecranon fractures with Herbert screws is a safe and easy method in young patients, leading to good functional and radiological results.

The study was conducted at - Department of Pediatric Surgery, Qilu Hospital of Shandong University, Shandong, China. The study has been published in Indian Journal of Orthopaedics.

The authors retrospectively reviewed the records of children treated at their center for isolated olecranon fractures (Mayo type IIA) with closed reduction and percutaneous Herbert screw fixation.

Surgical technique: After anesthesia induction, the patient was placed in the supine position, and the affected limb was placed on a C-arm X-ray device and sterilized. Because of the extension force of the triceps tendon, the fracture was generally displaced proximally and posteriorly; thus, the elbow was kept straight. In some patients, fracture reduction was difficult to perform, and it was needed to temporarily place a Kirschner wire into the proximal fracture end and use it to pry the reduction. After fracture reduction, the fracture block was pressed with fingers or a Kirschner wire and implanted two 0.8-mm Kirschner guide wires from the proximal to the distal end. Due to the fracture angle, it was difficult to pass the Kirschner wires through the proximal ulnar bone cortex. Following the direction of the Kirschner guide wires, two Herbert screws with a diameter of 3.0 mm was implanted and withdrew the Kirschner wires. The elbow joint was moved to detect the presence of obstructive sensation or limitation in joint movement. Strong fixation of the olecranon fracture was observed. If the fracture was confirmed to be in good reduction during the surgery—firmly fixed fracture end, no displacement of the internal fixation device, and straight elbow joint with normal flexion activity—the forearm was placed in the functional position with the elbow joint flexed at 45 degrees and fixed with a polyester bandage.