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Scientific Articles   |    
Contribution of the Olecranon to Elbow StabilityAn in Vitro Biomechanical Study
Timothy H. Bell, MD1; Louis M. Ferreira, BSc, BEng1; Colin P. McDonald, PhD1; James A. Johnson, PhD1; Graham J.W. King, MD, MSc, FRCSC1
1 Departments of Surgery (T.H.B.), Biomedical Engineering (L.M.F, C.P.M., and J.A.J.), and Mechanical and Materials Engineering (J.A.J.), The University of Western Ontario, and Hand and Upper Limb Centre (G.J.W.K.), St. Joseph's Health Care London, 268 Grosvenor Street, London, ON N6A 4L6, Canada. E-mail address for G.J.W. King: gking@uwo.ca
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Canadian Institute for Health Research. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Departments of Surgery, Biomedical Engineering, and Mechanical and Materials Engineering, The University of Western Ontario, London, and the Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):949-957. doi: 10.2106/JBJS.H.01873
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Abstract

Background: 

The amount of the olecranon that can be removed without substantially affecting the kinematics and stability of the elbow is controversial. The purpose of this study was to determine the effect of serial resections of the olecranon on elbow kinematics and stability.

Methods: 

Eight fresh, previously frozen cadaver arms were mounted in an in vitro motion simulator, and kinematic data were obtained with use of an electromagnetic tracking system for active and passive motion. Flexion was studied in the varus, valgus, horizontal, and dependent positions. Custom-written three-dimensional computer navigation software was utilized to guide serial resection of the olecranon in 12.5% increments from 0% to 100%. A traditional triceps advancement repair was performed following each resection. Flexion angle, amount of olecranon resection, and active and passive motion measurements were compared.

Results: 

Serial resection of the olecranon resulted in a significant increase in varus-valgus angulation with the arm in the varus (p < 0.04) and valgus (p = 0.01) orientations. Ulnohumeral rotation significantly increased in the varus (p < 0.001) and valgus (p < 0.007) orientations. Angular (p = 0.02) and rotational (p < 0.001) kinematics were greater with passive compared with active motion. There was no difference in elbow kinematics following olecranon resection with the arm positioned in the horizontal and dependent positions.

Conclusions: 

Valgus-varus angulation and ulnohumeral rotation progressively increase with sequential excision of up to 75% of the olecranon. Elbow stability is progressively lost with sequential excision, with gross instability noted at resection of =87.5% of the olecranon.

Clinical Relevance: 

The olecranon is a key osseous constraint of the elbow. This study supports open reduction and internal fixation of displaced olecranon fractures, rather than olecranon excision and triceps advancement, when technically feasible. Rehabilitation of the elbow with the arm in the horizontal or dependent position should be considered following excision of the olecranon, while varus and valgus orientations should be avoided.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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