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.

Outpatient follow-ups and radiographic examinations were performed in all patients 21 days and 3 and 6 months after surgery. On the first postoperative visit 21 days after surgery, if the fracture line was blurred, the cast was removed and prompted functional activity. If the fracture line was clearly visible, cast removal was delayed until 5 weeks after the surgery. Removal of internal fixation was performed in most patients between 6 and 8 months after surgery.

The observations of the study were:

• Overall, 14 patients with an average age at the time of injury of 11.36 (range 10–14) years were included.

• All patients had good radiological and clinical outcomes at 6–8 months postoperatively.

• All had normal elbow ranges of motion and showed complete bone healing on radiographs.

• There was no foreign body irritation, implant migration, or osteoarthritis cases.

• Premature epiphyseal closure was noted in six patients.

• The average QuickDASH score was 1.58.

The authors commented - "In the present study, we found no significant contraindications for the use of Herbert screws in patients aged 10–14 years. None of the patients developed osteoarthritis during the short-term follow-up. Furthermore, the QuickDASH score for the elbow was inspiring. Compared with TBW and tension band suture (TBS) , Herbert screw fixation is a reasonable treatment option for olecranon fractures that can significantly reduce the incidence of persistent joint pain, implant migration, and particularly, foreign body irritation."

Further reading:

Short Term Outcomes of Herbert Screw Fixation for Isolated Olecranon Fractures in Children: A Single Institution Retrospective Study

Yang Li, Kelai Wang et al

Indian Journal of Orthopaedics (2022) 56:1174–1180

https://doi.org/10.1007/s43465-022-00609-4