Trauma 101: Orthopedics Study Tool

Indication

Undisplaced stable fractures with an intact extensor mechanism, and displaced fractures in frail low-demand elderly patients where surgery carries excessive risk.

Implant design notes

No implant. Brief splinting in extension or slight flexion followed by protected active motion.

Approach

Non-operative.

Steps overview

1. Test active extension against gravity to confirm extensor mechanism continuity
2. Splint at about sixty to ninety degrees for comfort for one to two weeks
3. Begin active-assisted flexion and gravity-assisted extension early
4. Avoid resisted extension until union
5. Radiograph at two and six weeks to confirm no progressive separation
6. Counsel about an expected extension lag in the deliberately non-operative elderly group

Notes

Stiffness after elbow injury is unforgiving; immobilisation beyond three weeks buys a contracture.

Indication

Simple transverse or short oblique displaced fractures without comminution and without ulnohumeral instability.

Implant design notes

Two parallel Kirschner wires with a figure-of-eight stainless wire loop that converts the distracting pull of the triceps into compression across the fracture during flexion. The wires should engage the anterior cortex of the ulna distally to resist backing out.

Approach

Posterior midline approach curving around the olecranon tip, directly onto the subcutaneous bone.

Steps overview

1. Lateral decubitus or prone with the arm over a bolster, tourniquet applied
2. Posterior incision curved around the olecranon; expose the fracture and irrigate out debris
3. Reduce the fragment anatomically with a clamp, checking the articular surface of the trochlear notch
4. Drill two parallel wires from the tip across the fracture to engage the anterior ulnar cortex
5. Pass the figure-of-eight wire through a transverse drill hole distally and around the wire ends
6. Tighten symmetrically on both limbs of the loop, then bury the bent wire ends under the triceps
7. Confirm articular reduction and hardware position fluoroscopically
8. Close and begin active motion within days

Notes

Symptomatic prominent hardware over subcutaneous bone is very common and removal rates are high. Non-anatomical technique narrows the trochlear notch and causes stiffness.

Indication

Comminuted fractures, oblique patterns extending distally, fracture-dislocations, and any injury where the coronoid or ulnohumeral stability is involved.

Implant design notes

Pre-contoured posterior locking plate that wraps over the olecranon tip, allowing screws into the tip and along the shaft. Locking screws help in osteoporotic bone; the plate is a bridging and buttressing construct rather than relying on interfragmentary compression alone.

Approach

Posterior approach, elevating a subperiosteal flap and identifying the ulnar nerve medially before applying the implant.

Steps overview

1. Position and expose posteriorly as above
2. Reconstruct the articular surface of the trochlear notch first, using the coronoid as a reference
3. Provisionally hold with wires and assess the radiocapitellar and ulnohumeral relationships
4. Contour and apply the plate over the tip, with a long screw down the ulnar medullary canal
5. Add shaft screws and address the coronoid or radial head if involved
6. Test elbow stability through a full arc; consider hinged fixation if it remains unstable
7. Close over the ulnar nerve without tethering it, and mobilise early

Notes

In fracture-dislocation patterns, the coronoid and the lateral collateral ligament complex determine stability — fixing the olecranon alone leaves an unstable elbow.