Olecranon Fracture Flashcards
Olecranon fractures have bimodal distribution. What does this term mean?
They occur with a bimodal age distribution; occurring in the young following high energy injuries and in the elderly (more common) following low energy indirect injuries.
Why are all olecranon fractures intra-articular fractures?
The olecranon is the region of the proximal ulna from its tip to the coronoid process. It articulates with the trochlea of the distal humerus, and all olecranon fractures are therefore intra-articular fractures by definition.
Briefly describe the pathophysiology of olecranon fractures
The olecranon is the site of insertion for the triceps muscles. Fractures of the olecranon typically result from indirect trauma when a patient falls on an outstretched arm, resulting in the sudden pull of the triceps (and brachialis) muscle. The triceps muscle will also act to further distract the fracture; this is important to appreciate as it influences the management of these injuries.
Less commonly, in younger patients, these are high energy injuries resulting from direct trauma and may be associated with other forearm injuries or fractures.
What are the clinical features of olecranon fracture?
Olecranon fractures typically present with a history of falling on an outstretched hand followed by elbow pain, swelling and lack of mobility.
On examination, there is typically tenderness when palpating over the posterior aspect of the elbow, with a potential palpable defect also present. The disruption to the triceps mechanism means often there is an inability to extend the elbow against gravity. Ensure to check the neurovascular status of the affect limb.
Why should the shoulder and wrist joints also be examined?
Other injuries associated with a fall on an outstretched hand include wrist ligament and bony injuries, and radial head fractures or dislocation. Therefore, the shoulder and wrist joints should also be examined.
What investigations should be ordered for olecranon fracture?
Note: laboratory
All patients admitted should have routine blood tests taken, including clotting screen and group and save.
What investigations should be ordered for olecranon fracture?
Note: imaging
Initial imaging should be via plain AP and lateral radiographs, of both the affected joint and potentially joints above and below too.
Generally, olecranon fractures are easily identifiable on a lateral projection and with the pull of the triceps have a degree of displacement. There are a variety of different classification systems used in describing olecranon fractures, including the Mayo classification and the Schatzker classification
CT imaging can be useful in evaluating more complex injuries and degree of comminution.
Briefly describe what is shown on the X-ray
An olecranon process fracture, on lateral plain radiograph.
How is treatment guided following an olecranon fracture?
Treatment is usually guided by the degree of displacement on imaging. Any complex injuries such as fracture dislocations or neurovascular compromise should warrant urgent senior discussion.
Briefly describe the non-operative management of olecranon fractures
Non-operative management is usually indicated for displacement <2mm, with immobilisation in 60-90 degrees elbow flexion and early introduction of range of motion at 1-2 weeks.
There is increasing use of non-operative management for all patients over 75, irrespective of displacement, as whilst the degree of extension may be lost, the functional outcome is often appropriate.
Briefly describe the operative management of olecranon fractures
Operative management is usually indicated for displacement >2mm, requiring (depending on fracture configuration) techniques such as tension band wiring (if fracture proximal to the coranoid process) or olecranon plating (if at level of, or distal to, the coranoid process) may be used.
There is a very high rate of removal of metalwork, as due to the very superficial nature of the injury, it often impacts the patient significantly.
What is shown in the X-ray?
Radiographs of an olecranon process fracture, before and after surgical management.
