Biomechanical Challenges of Olecranon Fractures in Patients With Parkinson’s Disease: A Case Analysis of Neuro-Orthopedic Collaborative Intervention Strategies

TL;DR

This paper presents a case study on managing repeated elbow fractures in a Parkinson's patient through a collaborative neuro-orthopedic approach.

Contribution

A novel neuro-orthopedic strategy using quantitative assessment to address biomechanical challenges in PD-related fractures.

Findings

Successful fixation was achieved after three procedures using a plate with tension band wiring.

Post-DBS, the patient showed significant improvement in tremor and elbow function.

Quantitative assessment guided fixation methods and improved functional outcomes.

Abstract

In the intricate landscape of Parkinson's disease (PD), patients face a notably elevated risk of fixation failure due to the motor dysfunction characteristic of this condition. This narrative presents a compelling case of recurrent olecranon fractures in a patient with PD. It highlights the clinical implications of a neuro-orthopedic collaborative strategy that is meticulously anchored in quantitative assessment. A 71-year-old male with PD, Unified Parkinson's Disease Rating Scale III (UPDRS III) score 45 and modified Ashworth scale grade 2, sustained a comminuted fracture of the right olecranon (classified as Mayo Clinic type IIB) following a fall. The initial fixation, performed with titanium cables, was followed by a secondary wire fixation. Both fixations ultimately failed, compromised by the biomechanical stresses caused by the tremor and muscle rigidity intrinsic to PD. The third intervention, which combined a plate with tension band wiring, resulted in successful fixation. After undergoing deep-brain stimulation (DBS), which alleviated his tremor symptoms, the patient sustained a contralateral olecranon fracture during rehabilitation. This fracture was effectively managed using the same fixation protocol. A neuro-orthopedic collaborative strategy was carefully implemented, using the UPDRS-III and modified Ashworth scale scores to quantify neurological impairment and guide the choice of fixation methods. Ultimately, successful fixation was achieved after three procedures on the right elbow and one on the left. Notably, post-DBS, the patient showed marked improvement in tremor symptoms and achieved a near-normal range of motion (flexion: 130°, extension lag: 10°) and an excellent Mayo Elbow Performance Score (MEPS) of 95/100 in both elbows during follow-up assessments. This neuro-orthopedic collaborative strategy, firmly based on quantitative assessment, effectively addresses the complex biomechanical challenges inherent in fracture management for patients with PD. This approach not only improves fixation success but also significantly enhances functional outcomes, reflecting meticulous planning and execution at every step.

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