[9] Olecranon Fractures Flashcards
Describe the age distribution of olecranon process fractures?
They occur with a bimodal age distribution, occuring in the young and elderly (more common)
What do olecranon process fracture follow in the young?
High energy injuries
What do olecranon process fractures follow in the elderly?
Low energy indirect injuries
What is the olecranon?
The region of the proximal ulna from its top to the coronoid process
What does the olecranon process articulate with?
The trochlea of the distal humerus
What is the result of the olecranon articulating with the trochlear of the distal humerus?
All olecranon fractures are intra-articular by definition
What is the olecranon the site of?
Insertion for the triceps muscle
What do fractures of the olecranon typically result from?
Indirect trauma when a patient falls on an outstretched arm, resulting in a sudden pull of the triceps
How does the triceps muscle act on a olecranon fracture?
It further acts to distract the fracture
Why is it important to consider the role of the triceps in an olecranon fracture?
It influences the management of these injuries
How can olecranon fractures occur in younger patients?
Less commonly, it is due to high energy injuries resulting from direct trauma
What might olecranon fractures caused by high energy direct trauma be associated with?
Other foreaem injuries or fractures
How to olecranon fractures typically present?
History of falling on outstretched hand followed by elbow pain, swelling, and lack of mobility
What may be found on examination in elbow fractures?
- Typically tenderness when palpating over the posterior aspect of the elbow, with a potential palpable defect present
- Inability to extent elbow against gravity
Why is there an inability to extent the elbow against gravity in an olecranon fracture?
Due to disruption of the triceps mechanism
What might happen regarding extension of elbow against gravity in minimally displaced olecranon fractures?
Extension is preserved (albeit tender), due to soft tissue attachments that remain in tact
What is it important to assess in examination of an olecranon fracture?
Neurovascular status of affected limb
What other injuries may be associated with a fall on the outstretched hand?
- Wrist (ligament and bony) injuries
- Radial head fractures or dislocation
What investigations should be performed in olecranon process fractures?
- Routine blood tests
- Imaging
What should be included in blood tests in olecranon process fractures?
Clotting screen and group and save
What initial imaging should be done in an olecranon process fracture?
Plain AP and lateral radiographs, of affected joint and potentially joints above and below too
On what radiograph view are olecranon process fractures generally easily identifiable?
Lateral view
Why do olecranon process fractures generally have a degree of displacement?
Due to the pull of the triceps
Give two examples of classification systems used in describing olecranon fractures?
- Mayo classification
- Schatzker classification
When might CT scanning be useful in olecranon process fractures?
In evaluating more complex injuries and degree of comminution
How should olecranon process fractures be immediately managed?
Ensure the patient is resuscitated appropriately and stabilised prior to definitive management, and ensure to provide adequate analgesia
What is treatment of olecranon process fractures guided by?
Degree of displacement on imaging
What should warrant urgent senior discussion in olecranon process fractures?
Any complex injuries, such as fracture dislocations or neurovascular compromise
What will management of olecranon process fractures often vary between?
- Centre
- Surgical preference
- Patient factors
What is non-operative management usually indicated for in olecranon process fractures?
Displacement <2mm
What is involved in the non-operative management of olecranon process fractures?
Immobilisation in 60-90 degrees elbow flexion, and early introduction of range of motion at 1-2 weeks
Who is there an increasing use of non-operative management for, irrespective of displacement?
All patients over 75
Why is there an increasing use of non-operative management for all patients over 75 with an olecranon process fracture?
Because though the degree of extension may be lost, the functional outcome is often appropriate
What is operative management of olecranon process fractures usually indicated by?
Disaplacement >2mm
What techniques can be used in the operative management of olecranon process fractures?
- Tension band wiring
- Olecranon plating
When will tension band wiring be used in olecranon process fractures?
If the fracture is proximal to the coranoid process
When will olecranon plating be used in olecranon process fractures?
When the fracture is proximal to the coranoid process
When will olecranon plating be used in olecranon process fractures?
If the fracture is at the level of, or distal to, the coranoid process
Why is there a very high rate of removal of metalwork in olecranon process fractures?
Due to the very superficial nature of the injury, the metalwork often impacts the patient significantly
