PMC2796233_01
A 24-year-old previously healthy woman fell from standing height directly on her left elbow and sustained an isolated comminuted olecranon fracture (a) She was treated in an outside hospital with a figure-of-eight tension band construct. Intraoperative views with an image intensifier reveal marginal reduction of the fragments and incongruency of the ulnohumeral joint (b).
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A 24-year-old previously healthy woman fell from standing height directly on her left elbow and sustained an isolated comminuted olecranon fracture with axial impaction and depression of the articular joint surface (Figure 1(a)). Intraoperative views with an image intensifier reveal marginal reduction of the fragments and incongruency of the ulnohumeral joint (Figure 1(b)).
Computed tomographic evaluation revealed depression of the articular surface of the trochlear notch and shortening of the proximal ulna. She had an incongruent ulnohumeral joint leading to impingement and loss of function. The articular surfaces of the radio-capitellar joint remained opposed.
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The articular surfaces of the radiocapitellar joint remained opposed (Figure 2). 
An iliac-crest bone graft, 6 mm by 15 mm in size, was interposed to widen and reconstruct the trochlear notch. After lengthening of the proximal olecranon, the humerus could be easily reduced to restore ulnohumeral congruency. Stable fixation was achieved with 2 lag screws secured with a 4-hole LCP plate.
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Stable fixation was achieved with 2 lag screws secured with a 4-hole LCP plate (Figure 3).
Two years after the index surgery she had a functional elbow with 105 degrees of ulnohumeral motion (115 degrees of flexion (a) and a 10-degree flexion contracture (b)), 87 points according to American Shoulder and Elbow Surgeon evaluation and 7 points on the Disability of Arm Shoulder and Hand score.
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