Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)
Abstract Purpose The Proximal Ulna Dorsal Angulation (PUDA) is part of the proximal ulna’s normal anatomy. The importance of restoring ulnar anatomy characteristics precisely after olecranon fracture is not known, however, failure to recreate the PUDA after surgery may result in poorer functional ou...
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| Veröffentlicht in: | Injury 2016-11, Vol.47 (11), p.2520-2524 |
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| creator | Chapleau, Julien, MD, MSc Balg, Frédéric, MD, FRCSC Harvey, Edward J, MD, FRCSC Ménard, Jérémie, Ing Vauclair, Frédéric, MD Laflamme, G.-Yves, MD, FRCSC Hebert-Davies, Jonah, MD, FRCSC Rouleau, Dominique M, MD, FRCSC |
| description | Abstract Purpose The Proximal Ulna Dorsal Angulation (PUDA) is part of the proximal ulna’s normal anatomy. The importance of restoring ulnar anatomy characteristics precisely after olecranon fracture is not known, however, failure to recreate the PUDA after surgery may result in poorer functional outcomes. The purpose of this study is to evaluate the impact of minimal proximal ulna malunion on elbow ROM and function at least one year after olecranon ORIF. Method A retrospective comparative cohort study took place in three level-1 trauma centers. Forty-nine adult volunteers who underwent ORIF for olecranon fracture were included. Patients were separated into two groups according to PUDA malreduction—defined as more than 5° of difference between the fractured and the contralateral elbow. Outcome measurements Radiographic ROM measurement, demographic data and quality of life questionnaires were recorded (PREE, MEPS, Q-DASH, SF12, VAS). Results The mean follow up was 3 years and 9 months (1 to 7 years). There was no difference in terms of outcome, quality of reduction or range of motion between patients treated with plate or tension band. The mean PUDA on the fracture side was different from the normal side (2.20 vs 4.90, p < 0.001). Fourteen patients (29%) had PUDA malunion. Those patients had decreased elbow flexion (−7°, p = 0.011), extension (−11.2°, p = 0.013) and total ROM (−18.6°, p = 0.006) as opposed to the control group. Both groups had comparable quality of life questionnaire scores. Alcohol consumption was the only risk factor associated with worse scores. Conclusion Incidence of olecranon malunion—as defined by PUDA measurement − was 29% and it was associated with decreased elbow range of motion. Alcohol consumption was correlated with a worse prognosis in our series of patients. Tension band and plate fixation can maintain a good reduction in terms of PUDA and the choice of fixation method does not influence outcome. Level of Evidence III Therapeutic study. |
| doi_str_mv | 10.1016/j.injury.2016.08.029 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1836728593</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0020138316304296</els_id><sourcerecordid>1836728593</sourcerecordid><originalsourceid>FETCH-LOGICAL-c487t-517ec80e258628bfa42f9d36e065b85186a7c10efbd3c48a9415c947cc7a93ac3</originalsourceid><addsrcrecordid>eNqFkUtv1DAUhS0EokPhHyDkZbtI8COxHRZIo5ZHpUpUKrO2PM4NdUjswY4R8-9xNIUFG1a2r885V_e7CL2mpKaEirdj7fyY47Fm5VUTVRPWPUEbqmRXESbkU7QhhJGKcsXP0IuURkKoJJw_R2dMCtoISTfo4WY-GLvgMOAwgY3GB4-HWEo5Ap7NlL0L_h2-X3J_xOVveQDs5kOIi_EWVt_d7nqLL-5i-OWKHu8mb_B1iKnct_5bnsxSEi5fomeDmRK8ejzP0e7jh69Xn6vbL59urra3lW2UXKqWSrCKAGuVYGo_mIYNXc8FENHuVUuVMNJSAsO-58Vhuoa2tmuktdJ03Fh-ji5OuYcYfmRIi55dsjBNxkPISVPFhWSq7XiRNiepjSGlCIM-xDJCPGpK9MpYj_rEWK-MNVG6MC62N48d8n6G_q_pD9QieH8SQJnzp4Ook3VQaPUugl10H9z_OvwbYCfnnTXTdzhCGkOOvjDUVCemib5f97yumQpOGtYJ_hup46RA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1836728593</pqid></control><display><type>article</type><title>Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Chapleau, Julien, MD, MSc ; Balg, Frédéric, MD, FRCSC ; Harvey, Edward J, MD, FRCSC ; Ménard, Jérémie, Ing ; Vauclair, Frédéric, MD ; Laflamme, G.-Yves, MD, FRCSC ; Hebert-Davies, Jonah, MD, FRCSC ; Rouleau, Dominique M, MD, FRCSC</creator><creatorcontrib>Chapleau, Julien, MD, MSc ; Balg, Frédéric, MD, FRCSC ; Harvey, Edward J, MD, FRCSC ; Ménard, Jérémie, Ing ; Vauclair, Frédéric, MD ; Laflamme, G.-Yves, MD, FRCSC ; Hebert-Davies, Jonah, MD, FRCSC ; Rouleau, Dominique M, MD, FRCSC</creatorcontrib><description>Abstract Purpose The Proximal Ulna Dorsal Angulation (PUDA) is part of the proximal ulna’s normal anatomy. The importance of restoring ulnar anatomy characteristics precisely after olecranon fracture is not known, however, failure to recreate the PUDA after surgery may result in poorer functional outcomes. The purpose of this study is to evaluate the impact of minimal proximal ulna malunion on elbow ROM and function at least one year after olecranon ORIF. Method A retrospective comparative cohort study took place in three level-1 trauma centers. Forty-nine adult volunteers who underwent ORIF for olecranon fracture were included. Patients were separated into two groups according to PUDA malreduction—defined as more than 5° of difference between the fractured and the contralateral elbow. Outcome measurements Radiographic ROM measurement, demographic data and quality of life questionnaires were recorded (PREE, MEPS, Q-DASH, SF12, VAS). Results The mean follow up was 3 years and 9 months (1 to 7 years). There was no difference in terms of outcome, quality of reduction or range of motion between patients treated with plate or tension band. The mean PUDA on the fracture side was different from the normal side (2.20 vs 4.90, p < 0.001). Fourteen patients (29%) had PUDA malunion. Those patients had decreased elbow flexion (−7°, p = 0.011), extension (−11.2°, p = 0.013) and total ROM (−18.6°, p = 0.006) as opposed to the control group. Both groups had comparable quality of life questionnaire scores. Alcohol consumption was the only risk factor associated with worse scores. Conclusion Incidence of olecranon malunion—as defined by PUDA measurement − was 29% and it was associated with decreased elbow range of motion. Alcohol consumption was correlated with a worse prognosis in our series of patients. Tension band and plate fixation can maintain a good reduction in terms of PUDA and the choice of fixation method does not influence outcome. Level of Evidence III Therapeutic study.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2016.08.029</identifier><identifier>PMID: 27614671</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Elbow Joint - anatomy & histology ; Elbow Joint - diagnostic imaging ; Elbow Joint - physiopathology ; Elbow Joint - surgery ; Female ; Fracture Fixation, Internal ; Fractures, Malunited - diagnostic imaging ; Fractures, Malunited - physiopathology ; Fractures, Malunited - surgery ; Humans ; Male ; Malunion ; Olecranon Process - diagnostic imaging ; Olecranon Process - injuries ; Olecranon Process - physiopathology ; Olecranon Process - surgery ; Orthopedics ; Proximal fracture ; PUDA ; Radiographic study ; Radiography ; Range of Motion, Articular - physiology ; Retrospective Studies ; ROM ; Treatment Outcome ; Ulna ; Ulna - anatomy & histology ; Ulna - diagnostic imaging ; Ulna Fractures - diagnostic imaging ; Ulna Fractures - physiopathology ; Ulna Fractures - surgery ; Young Adult</subject><ispartof>Injury, 2016-11, Vol.47 (11), p.2520-2524</ispartof><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-517ec80e258628bfa42f9d36e065b85186a7c10efbd3c48a9415c947cc7a93ac3</citedby><cites>FETCH-LOGICAL-c487t-517ec80e258628bfa42f9d36e065b85186a7c10efbd3c48a9415c947cc7a93ac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2016.08.029$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27614671$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chapleau, Julien, MD, MSc</creatorcontrib><creatorcontrib>Balg, Frédéric, MD, FRCSC</creatorcontrib><creatorcontrib>Harvey, Edward J, MD, FRCSC</creatorcontrib><creatorcontrib>Ménard, Jérémie, Ing</creatorcontrib><creatorcontrib>Vauclair, Frédéric, MD</creatorcontrib><creatorcontrib>Laflamme, G.-Yves, MD, FRCSC</creatorcontrib><creatorcontrib>Hebert-Davies, Jonah, MD, FRCSC</creatorcontrib><creatorcontrib>Rouleau, Dominique M, MD, FRCSC</creatorcontrib><title>Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)</title><title>Injury</title><addtitle>Injury</addtitle><description>Abstract Purpose The Proximal Ulna Dorsal Angulation (PUDA) is part of the proximal ulna’s normal anatomy. The importance of restoring ulnar anatomy characteristics precisely after olecranon fracture is not known, however, failure to recreate the PUDA after surgery may result in poorer functional outcomes. The purpose of this study is to evaluate the impact of minimal proximal ulna malunion on elbow ROM and function at least one year after olecranon ORIF. Method A retrospective comparative cohort study took place in three level-1 trauma centers. Forty-nine adult volunteers who underwent ORIF for olecranon fracture were included. Patients were separated into two groups according to PUDA malreduction—defined as more than 5° of difference between the fractured and the contralateral elbow. Outcome measurements Radiographic ROM measurement, demographic data and quality of life questionnaires were recorded (PREE, MEPS, Q-DASH, SF12, VAS). Results The mean follow up was 3 years and 9 months (1 to 7 years). There was no difference in terms of outcome, quality of reduction or range of motion between patients treated with plate or tension band. The mean PUDA on the fracture side was different from the normal side (2.20 vs 4.90, p < 0.001). Fourteen patients (29%) had PUDA malunion. Those patients had decreased elbow flexion (−7°, p = 0.011), extension (−11.2°, p = 0.013) and total ROM (−18.6°, p = 0.006) as opposed to the control group. Both groups had comparable quality of life questionnaire scores. Alcohol consumption was the only risk factor associated with worse scores. Conclusion Incidence of olecranon malunion—as defined by PUDA measurement − was 29% and it was associated with decreased elbow range of motion. Alcohol consumption was correlated with a worse prognosis in our series of patients. Tension band and plate fixation can maintain a good reduction in terms of PUDA and the choice of fixation method does not influence outcome. Level of Evidence III Therapeutic study.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Elbow Joint - anatomy & histology</subject><subject>Elbow Joint - diagnostic imaging</subject><subject>Elbow Joint - physiopathology</subject><subject>Elbow Joint - surgery</subject><subject>Female</subject><subject>Fracture Fixation, Internal</subject><subject>Fractures, Malunited - diagnostic imaging</subject><subject>Fractures, Malunited - physiopathology</subject><subject>Fractures, Malunited - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Malunion</subject><subject>Olecranon Process - diagnostic imaging</subject><subject>Olecranon Process - injuries</subject><subject>Olecranon Process - physiopathology</subject><subject>Olecranon Process - surgery</subject><subject>Orthopedics</subject><subject>Proximal fracture</subject><subject>PUDA</subject><subject>Radiographic study</subject><subject>Radiography</subject><subject>Range of Motion, Articular - physiology</subject><subject>Retrospective Studies</subject><subject>ROM</subject><subject>Treatment Outcome</subject><subject>Ulna</subject><subject>Ulna - anatomy & histology</subject><subject>Ulna - diagnostic imaging</subject><subject>Ulna Fractures - diagnostic imaging</subject><subject>Ulna Fractures - physiopathology</subject><subject>Ulna Fractures - surgery</subject><subject>Young Adult</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtv1DAUhS0EokPhHyDkZbtI8COxHRZIo5ZHpUpUKrO2PM4NdUjswY4R8-9xNIUFG1a2r885V_e7CL2mpKaEirdj7fyY47Fm5VUTVRPWPUEbqmRXESbkU7QhhJGKcsXP0IuURkKoJJw_R2dMCtoISTfo4WY-GLvgMOAwgY3GB4-HWEo5Ap7NlL0L_h2-X3J_xOVveQDs5kOIi_EWVt_d7nqLL-5i-OWKHu8mb_B1iKnct_5bnsxSEi5fomeDmRK8ejzP0e7jh69Xn6vbL59urra3lW2UXKqWSrCKAGuVYGo_mIYNXc8FENHuVUuVMNJSAsO-58Vhuoa2tmuktdJ03Fh-ji5OuYcYfmRIi55dsjBNxkPISVPFhWSq7XiRNiepjSGlCIM-xDJCPGpK9MpYj_rEWK-MNVG6MC62N48d8n6G_q_pD9QieH8SQJnzp4Ook3VQaPUugl10H9z_OvwbYCfnnTXTdzhCGkOOvjDUVCemib5f97yumQpOGtYJ_hup46RA</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Chapleau, Julien, MD, MSc</creator><creator>Balg, Frédéric, MD, FRCSC</creator><creator>Harvey, Edward J, MD, FRCSC</creator><creator>Ménard, Jérémie, Ing</creator><creator>Vauclair, Frédéric, MD</creator><creator>Laflamme, G.-Yves, MD, FRCSC</creator><creator>Hebert-Davies, Jonah, MD, FRCSC</creator><creator>Rouleau, Dominique M, MD, FRCSC</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)</title><author>Chapleau, Julien, MD, MSc ; Balg, Frédéric, MD, FRCSC ; Harvey, Edward J, MD, FRCSC ; Ménard, Jérémie, Ing ; Vauclair, Frédéric, MD ; Laflamme, G.-Yves, MD, FRCSC ; Hebert-Davies, Jonah, MD, FRCSC ; Rouleau, Dominique M, MD, FRCSC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-517ec80e258628bfa42f9d36e065b85186a7c10efbd3c48a9415c947cc7a93ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Elbow Joint - anatomy & histology</topic><topic>Elbow Joint - diagnostic imaging</topic><topic>Elbow Joint - physiopathology</topic><topic>Elbow Joint - surgery</topic><topic>Female</topic><topic>Fracture Fixation, Internal</topic><topic>Fractures, Malunited - diagnostic imaging</topic><topic>Fractures, Malunited - physiopathology</topic><topic>Fractures, Malunited - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Malunion</topic><topic>Olecranon Process - diagnostic imaging</topic><topic>Olecranon Process - injuries</topic><topic>Olecranon Process - physiopathology</topic><topic>Olecranon Process - surgery</topic><topic>Orthopedics</topic><topic>Proximal fracture</topic><topic>PUDA</topic><topic>Radiographic study</topic><topic>Radiography</topic><topic>Range of Motion, Articular - physiology</topic><topic>Retrospective Studies</topic><topic>ROM</topic><topic>Treatment Outcome</topic><topic>Ulna</topic><topic>Ulna - anatomy & histology</topic><topic>Ulna - diagnostic imaging</topic><topic>Ulna Fractures - diagnostic imaging</topic><topic>Ulna Fractures - physiopathology</topic><topic>Ulna Fractures - surgery</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chapleau, Julien, MD, MSc</creatorcontrib><creatorcontrib>Balg, Frédéric, MD, FRCSC</creatorcontrib><creatorcontrib>Harvey, Edward J, MD, FRCSC</creatorcontrib><creatorcontrib>Ménard, Jérémie, Ing</creatorcontrib><creatorcontrib>Vauclair, Frédéric, MD</creatorcontrib><creatorcontrib>Laflamme, G.-Yves, MD, FRCSC</creatorcontrib><creatorcontrib>Hebert-Davies, Jonah, MD, FRCSC</creatorcontrib><creatorcontrib>Rouleau, Dominique M, MD, FRCSC</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chapleau, Julien, MD, MSc</au><au>Balg, Frédéric, MD, FRCSC</au><au>Harvey, Edward J, MD, FRCSC</au><au>Ménard, Jérémie, Ing</au><au>Vauclair, Frédéric, MD</au><au>Laflamme, G.-Yves, MD, FRCSC</au><au>Hebert-Davies, Jonah, MD, FRCSC</au><au>Rouleau, Dominique M, MD, FRCSC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation)</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>47</volume><issue>11</issue><spage>2520</spage><epage>2524</epage><pages>2520-2524</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract>Abstract Purpose The Proximal Ulna Dorsal Angulation (PUDA) is part of the proximal ulna’s normal anatomy. The importance of restoring ulnar anatomy characteristics precisely after olecranon fracture is not known, however, failure to recreate the PUDA after surgery may result in poorer functional outcomes. The purpose of this study is to evaluate the impact of minimal proximal ulna malunion on elbow ROM and function at least one year after olecranon ORIF. Method A retrospective comparative cohort study took place in three level-1 trauma centers. Forty-nine adult volunteers who underwent ORIF for olecranon fracture were included. Patients were separated into two groups according to PUDA malreduction—defined as more than 5° of difference between the fractured and the contralateral elbow. Outcome measurements Radiographic ROM measurement, demographic data and quality of life questionnaires were recorded (PREE, MEPS, Q-DASH, SF12, VAS). Results The mean follow up was 3 years and 9 months (1 to 7 years). There was no difference in terms of outcome, quality of reduction or range of motion between patients treated with plate or tension band. The mean PUDA on the fracture side was different from the normal side (2.20 vs 4.90, p < 0.001). Fourteen patients (29%) had PUDA malunion. Those patients had decreased elbow flexion (−7°, p = 0.011), extension (−11.2°, p = 0.013) and total ROM (−18.6°, p = 0.006) as opposed to the control group. Both groups had comparable quality of life questionnaire scores. Alcohol consumption was the only risk factor associated with worse scores. Conclusion Incidence of olecranon malunion—as defined by PUDA measurement − was 29% and it was associated with decreased elbow range of motion. Alcohol consumption was correlated with a worse prognosis in our series of patients. Tension band and plate fixation can maintain a good reduction in terms of PUDA and the choice of fixation method does not influence outcome. Level of Evidence III Therapeutic study.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>27614671</pmid><doi>10.1016/j.injury.2016.08.029</doi><tpages>5</tpages></addata></record> |
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| subjects | Adolescent Adult Elbow Joint - anatomy & histology Elbow Joint - diagnostic imaging Elbow Joint - physiopathology Elbow Joint - surgery Female Fracture Fixation, Internal Fractures, Malunited - diagnostic imaging Fractures, Malunited - physiopathology Fractures, Malunited - surgery Humans Male Malunion Olecranon Process - diagnostic imaging Olecranon Process - injuries Olecranon Process - physiopathology Olecranon Process - surgery Orthopedics Proximal fracture PUDA Radiographic study Radiography Range of Motion, Articular - physiology Retrospective Studies ROM Treatment Outcome Ulna Ulna - anatomy & histology Ulna - diagnostic imaging Ulna Fractures - diagnostic imaging Ulna Fractures - physiopathology Ulna Fractures - surgery Young Adult |
| title | Impact of olecranon fracture malunion: Study on the importance of PUDA (Proximal Ulna Dorsal Angulation) |
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