Devising Osteosynthesis for the Reverse Oblique Olecranon Fracture: A Case Report.

Introduction: We encountered a patient with a reverse oblique olecranon fracture in whom redisplacement occurred after osteosynthesis using routine tension band wiring (TBW). In this case report, methods for stable fixation used during reoperation are reported with a review of the literature. Case Report: A 60-year-old male got the left olecranon fracture (Colton classification, type 2A) visited our hospital. However, osteosynthesis using TBW was performed, soft wire breakage, K-wire distortion, and olecranon bone fragment displacement at 2 weeks after surgery. Reoperation was performed. TBW was performed using K-wires as intramedullary nails so that compression force could be applied as vertically as possible to the bone fragments. Furthermore, for further control of distal bone fragment instability, olecranon locking plate fixation was performed using a posterior approach. 12 months after the operation, the visual analog scale score was 2/10, Quick Disabilities of the Arm, Shoulder, and Hand score were 2.27/100, and the Mayo Elbow Performance score was 85/100 (good). Plain X-ray examination showed favorable bone union. Conclusion: In reverse oblique fractures, the compression force applied to the fracture site is weak because it is not vertical to the fracture line. Therefore, stable osteosynthesis cannot be performed, and post-operative redisplacement occurs. The combination of TBW and plates should be actively considered in reverse oblique olecranon fractures for which adequate fixation cannot be provided by TBW alone.