Quantitative 3-dimensional computed tomography analysis and 2-dimensional-fracture mapping of olecranon fractures.

Lubberts, B. (Bart) (2014) Quantitative 3-dimensional computed tomography analysis and 2-dimensional-fracture mapping of olecranon fractures. thesis, Medicine.

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Abstract

Background Quantitative 3-dimensional computed tomography (Q3DCT) and 2-dimensional (2D) fracture mapping could provide a more detailed understanding of fracture patterns and morphology, which might help in surgical decision making. We applied these techniques to Mayo Type I (nondisplaced), Mayo Type II (displaced stable) and Mayo Type III (displaced unstable) olecranon fractures and tried to determine fracture patterns and morphology. Methods We retrospectively analysed a consecutive series of 78 olecranon fractures using Q3DCT and 2D fracture mapping. Using 3D Slicer, we created 3-dimensional models, which were exported into Rhinoceros to measure the total number of fracture fragments, the volume and articular surface area of each fracture fragment and the degree of displacement of the most proximal olecranon fracture fragment. Images of olecranon fractures needed for 2D fracture mapping were based on Q3DCT modeling techniques. Using Macromedia Fireworks MX software 2D fracture lines were drawn. Six cases had a Mayo Type I, 22 a Mayo Type II and 50 a Mayo Type III fracture. Mayo Type III fractures where classified into 27 anterior and 23 posterior olecranon fracture-dislocations. Radial head fractures were present in 21 olecranon fractures. Results The median percentage of the articular surface involvement of the most proximal olecranon fragment was 56% in Mayo Type I, 34% in Mayo Type II and 55% in Mayo Type III fractures (p-value < 0.001). The median percentage of volume of the most proximal olecranon fragment was 60% in Mayo Type I, 36% in Mayo Type II and 53% in Mayo Type III fractures (p-value < 0.001). Number of fracture fragments was 2.5 in Mayo Type I and 4 in both Mayo Type II and III fractures (p-value 0.02). The median percentage of the articular surface involvement of the most proximal olecranon fragment was 46% in anterior and 59% in posterior fracture-dislocations (p-value 0.001). The median percentage of volume of the most proximal olecranon fragment was 45% in anterior and 69% in posterior fracture-dislocations (p-value 0.005). Degree of displacement was 20mm in anterior and 15mm in posterior fracture-dislocations (p-value 0.04). Two-dimensional fracture mapping showed that fracture lines located at the base of the coronoid (located distal in the ulnar trochlear notch) were more common in Mayo Type III fractures, resulting in ulnohumeral instability. Conclusion Fractures of the olecranon can be complex and treatment should be aimed at restoring congruity of the articular surface and stability of the elbow. A variety of fixation techniques are available to surgeons. Yet there is little consensus in the surgical treatment of olecranon fractures and little comparative research to guide the clinician. Our data emphasize that determining the Mayo classification can be helpful for predicting the injury patterns and morphology of olecranon fractures and can therefore facilitate pre-operative planning of surgical approach, fixation techniques, and overall treatment of the injury.

Item Type:	Thesis (Thesis)
Supervisor name:	Diercks, Prof. Dr. R.L.
Supervisor name:	Nota, Drs. S.P. and Ring, Dr. David and Massachusetts General Hospital and Harvard Medical School
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:48
Last Modified:	25 Jun 2020 10:48
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/945

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