Transolecranon fracture-dislocations of the elbow: a case series of 15 patients

Transolecranon fracture-dislocations are rare, misdiagnosed, and challenging traumatic injuries. Consensually, they are managed surgically to restore a mobile, stable and painless elbow joint. There  is a relative paucity of studies  on this  subject  in the  literature. The purpose of this case series was to establish the epidemiological profile and to describe clinical, radiological, therapeutic and outcome characteristics of these lesions. Between 2007 and 2016, fifteen patients with median age of 36 years (18-65 years) presented to us with transolecranon fracture-dislocations. They were treated surgically and followed regularly with a mean follow-up of 46 months. The  cause in  the majority of cases was high-energy trauma,  mainly traffic accidents  (80%). Proximal ulna fractures were comminuted in 12 patients (80%) and open in three cases (25%). Open reduction and internal fixation with 3.5 mm reconstruction plates through a posterior approach was used in all cases. During follow up, one patient (6%) had developed wound infection with skin necrosis which was successfully managed by antibiotics and controlled wound healing. Solid osseous union was confirmed for all fractures with an average of 13.5 weeks. At final follow-up, 14 patients (93%) reported excellent outcome with a mean Broberg and Morrey score (BMS) of 86.3. Although rare, transolecranon fracture-dislocations found in patients hospitalized in a high-complexity service occurred in young men who were involved in motor vehicle accidents. These injuries can be treated successfully with reconstruction plate through a posterior approach to achieve and maintain anatomical reduction by rigid internal fixation, which is essential for promoting early rehabilitation.