Olecranon Fracture

Question 1

Epidemiology

Answer 1

Relatively common

Bimodal age distribution

Young = High energy injury

Elderly (more common) = Low energy indirect injuries

Question 2

Pathophysiology

Answer 2

All olecranon fractures are intra-articular fractures by definition.

Typically result from indirect trauma when a patient FOOSH leading to a sudden pull of triceps and brachialis muscle.

The triceps will then further distract the fracture (influencing the management)

If it is younger patients by high energy direct trauma other forearm injuries might be concurrent.

Question 3

Clinical features

Answer 3

FOOSH + elbow pain, swelling and lack of mobility

Question 4

Examination findings

Answer 4

Tenderness palpating posterior aspect of elbow

Potentially a palpable defect

Inability to extend the elbow against gravity (triceps not working properly due to its insertion on olecranon)

Question 5

What else should be examined?

Answer 5

Neurovascular examination

Also check shoulder and wrist since wrist ligament and bony injuries + radial head fractures or dislocations can happen as well.

Question 6

Is extension preserved in minimally displaced olecranon fractures?

Answer 6

Yes due to soft tissue atachments that remain intact

Question 7

Investigations

Answer 7

Routine blood tests + clotting + Group & Save

Plain AP and lateral radiographs of elbow and maybe of shoulder and wrist as well.

CT can be useful in more complex injuries

Question 8

X-ray findings

Answer 8

Easily identifiable on lateral projection and with the pull of the triceps have a degree of displacement.

Question 9

Classifications systems

Answer 9

Mayo classification

Schatzker classification

Question 10

What is management guided by?

Answer 10

Degree of displacement provided by imaging.

Question 11

General management

Answer 11

Resuscitation and stabilise prior to definitive management

Ensure adequate analgesia

Question 12

Indications of conservative management.

Answer 12

Displacement < 2mm

Increasing use of conservative management for patients over 75 regardless of displacement.
Extension might be lost but functional outcome is often appropriate

Question 13

Explain conservative management

Answer 13

Immobilisation in 60-90 degrees elbow flexion

Start range of motion exercise 1-2 weeks in.

Question 14

Indications of surgical management.

Answer 14

Displacement > 2mm

Open fracture

Neurovascular compromise

Question 15

Explain surgical management

Answer 15

Fracture proximal to coranoid process -> Tension band wiring

At level or distal to coranoid process -> Olecranon plating

Usually you remove the metalwork as well due to superficial nature of the injury and usually helps the patient in comfort and motion.