Tension Suture Fixation of Olecranon Fractures: Introduction скачать в хорошем качестве

Tension Suture Fixation of Olecranon Fractures: Introduction

Video 2 of 15 from the JBJS EST article, Tension Suture Fixation of Olecranon Fractures by Joideep Phadnis, by Timothy Eves, Adam C. Watts. Published June 3, 2021. ➡️ https://bit.ly/32M6NI6 Journal: JBJS Essential Surgical Techniques ➡️ https://jbjs.org/journal.php?j=est Subspecialties: Elbow, Trauma Background: Mayo type-IIA olecranon fractures are characterized by a transverse or short oblique fracture without articular comminution or ulnohumeral instability. Traditionally, these fractures are treated with a tension-band wiring technique. Despite good rates of fracture union, tension-band wiring is associated with a reoperation rate of 30% to 60%, usually for removal of prominent metalwork. The tension suture technique was developed as an alternative method of fixing Mayo type-IIA fractures using only high-tensile braided nonabsorbable number-2 sutures, with the aim of reducing the reoperation rate associated with tension-band wiring without compromising outcomes. The tension suture technique has subsequently become the only technique we use when treating these fractures. Description: The patient is positioned in the lateral decubitus position under general or regional anesthesia. A direct posterior approach is made, centered over the fracture. The fracture is identified, cleared of hematoma, and reduced with use of a large, pointed reduction clamp to provide interfragmentary compression. A 2.5-mm transverse drill hole is made through the ulna distal to the fracture site. Two sets of number-2 braided nonabsorbable sutures are utilized. The first sutures are passed lateral to medial through the drill hole and used to grasp the medial triceps insertion onto the proximal fragment, then passed back through the transverse drill hole from medial to lateral and used to grasp the lateral triceps insertion onto the proximal fragment. The suture ends are tensioned to remove slack and tied on the lateral aspect of the olecranon. The second sutures are then passed lateral to medial through the transverse drill hole but this time used to grasp the posterolateral triceps insertion on the proximal fragment, then re-passed through the transverse drill hole from medial to lateral, and finally used to grasp the posteromedial triceps insertion. The suture limbs are tensioned and tied on the lateral aspect of the ulna next to the first suture. The clamp is removed, and the construct is tested under full range of motion to ensure there is no evidence of gapping. Fluoroscopy is utilized to confirm reduction before the wound is irrigated and closed in a standard fashion. Keywords: JBJS, EST, Essential Surgical Techniques, Key Procedures, tension suture repair, olecranon, Mayo type 2a fracture, ulnohumeral instability, tension band wiring, Professor Adam Watts, reoperation rate, complications, all-suture technique, braided non-absorbable synthetic sutures, drill hole, ulna, triceps, compression, rehabilitation, healing