[9] Olecranon Fractures

Question 1

Describe the age distribution of olecranon process fractures?

Answer 1

They occur with a bimodal age distribution, occuring in the young and elderly (more common)

Question 2

What do olecranon process fracture follow in the young?

Answer 2

High energy injuries

Question 3

What do olecranon process fractures follow in the elderly?

Answer 3

Low energy indirect injuries

Question 4

What is the olecranon?

Answer 4

The region of the proximal ulna from its top to the coronoid process

Question 5

What does the olecranon process articulate with?

Answer 5

The trochlea of the distal humerus

Question 6

What is the result of the olecranon articulating with the trochlear of the distal humerus?

Answer 6

All olecranon fractures are intra-articular by definition

Question 7

What is the olecranon the site of?

Answer 7

Insertion for the triceps muscle

Question 8

What do fractures of the olecranon typically result from?

Answer 8

Indirect trauma when a patient falls on an outstretched arm, resulting in a sudden pull of the triceps

Question 9

How does the triceps muscle act on a olecranon fracture?

Answer 9

It further acts to distract the fracture

Question 10

Why is it important to consider the role of the triceps in an olecranon fracture?

Answer 10

It influences the management of these injuries

Question 11

How can olecranon fractures occur in younger patients?

Answer 11

Less commonly, it is due to high energy injuries resulting from direct trauma

Question 12

What might olecranon fractures caused by high energy direct trauma be associated with?

Answer 12

Other foreaem injuries or fractures

Question 13

How to olecranon fractures typically present?

Answer 13

History of falling on outstretched hand followed by elbow pain, swelling, and lack of mobility

Question 14

What may be found on examination in elbow fractures?

Answer 14

• Typically tenderness when palpating over the posterior aspect of the elbow, with a potential palpable defect present
• Inability to extent elbow against gravity

Question 15

Why is there an inability to extent the elbow against gravity in an olecranon fracture?

Answer 15

Due to disruption of the triceps mechanism

Question 16

What might happen regarding extension of elbow against gravity in minimally displaced olecranon fractures?

Answer 16

Extension is preserved (albeit tender), due to soft tissue attachments that remain in tact

Question 17

What is it important to assess in examination of an olecranon fracture?

Answer 17

Neurovascular status of affected limb

Question 18

What other injuries may be associated with a fall on the outstretched hand?

Answer 18

• Wrist (ligament and bony) injuries
• Radial head fractures or dislocation

Question 19

What investigations should be performed in olecranon process fractures?

Answer 19

• Routine blood tests
• Imaging

Question 20

What should be included in blood tests in olecranon process fractures?

Answer 20

Clotting screen and group and save

Question 21

What initial imaging should be done in an olecranon process fracture?

Answer 21

Plain AP and lateral radiographs, of affected joint and potentially joints above and below too

Question 22

On what radiograph view are olecranon process fractures generally easily identifiable?

Answer 22

Lateral view

Question 23

Why do olecranon process fractures generally have a degree of displacement?

Answer 23

Due to the pull of the triceps

Question 24

Give two examples of classification systems used in describing olecranon fractures?

Answer 24

• Mayo classification
• Schatzker classification

Question 25

When might CT scanning be useful in olecranon process fractures?

Answer 25

In evaluating more complex injuries and degree of comminution

Question 26

How should olecranon process fractures be immediately managed?

Answer 26

Ensure the patient is resuscitated appropriately and stabilised prior to definitive management, and ensure to provide adequate analgesia

Question 27

What is treatment of olecranon process fractures guided by?

Answer 27

Degree of displacement on imaging

Question 28

What should warrant urgent senior discussion in olecranon process fractures?

Answer 28

Any complex injuries, such as fracture dislocations or neurovascular compromise

Question 29

What will management of olecranon process fractures often vary between?

Answer 29

• Centre
• Surgical preference
• Patient factors

Question 30

What is non-operative management usually indicated for in olecranon process fractures?

Answer 30

Displacement <2mm

Question 31

What is involved in the non-operative management of olecranon process fractures?

Answer 31

Immobilisation in 60-90 degrees elbow flexion, and early introduction of range of motion at 1-2 weeks

Question 32

Who is there an increasing use of non-operative management for, irrespective of displacement?

Answer 32

All patients over 75

Question 33

Why is there an increasing use of non-operative management for all patients over 75 with an olecranon process fracture?

Answer 33

Because though the degree of extension may be lost, the functional outcome is often appropriate

Question 34

What is operative management of olecranon process fractures usually indicated by?

Answer 34

Disaplacement >2mm

Question 35

What techniques can be used in the operative management of olecranon process fractures?

Answer 35

• Tension band wiring
• Olecranon plating

Question 36

When will tension band wiring be used in olecranon process fractures?

Answer 36

If the fracture is proximal to the coranoid process

Question 37

When will olecranon plating be used in olecranon process fractures?

Answer 37

When the fracture is proximal to the coranoid process

Question 38

When will olecranon plating be used in olecranon process fractures?

Answer 38

If the fracture is at the level of, or distal to, the coranoid process

Question 39

Why is there a very high rate of removal of metalwork in olecranon process fractures?

Answer 39

Due to the very superficial nature of the injury, the metalwork often impacts the patient significantly