Olecranon fractures + bursitis

Question 1

Olecranon fracture type

Answer 1

All intra-articular fractures

Question 2

What inserts on teh olecranon

Answer 2

triceps tendon

Question 3

Mechanism of injury

Answer 3

FOOSH resulting in the sudden pull of the triceps (and brachialis) muscle.

Question 4

Clinical features

Answer 4

Elbow pain
Swelling
Lack of mobility.

On examination:

• tenderness over the posterior aspect of the elbow, a potential palpable defect
• Inability to extend the elbow against gravity

Question 5

Investigations

Answer 5

Routine blood tests - including clotting screen and group and save.

Xray - AP and lateral radiographs of joint and potentially joints above and below too.

CT imaging can be useful in evaluating more complex injuries and degree of comminution

Question 6

Non-operative management

Answer 6

ATLS
Analgesia

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

Question 7

Indications for non-operative management

Answer 7

Displacement <2mm

Increasing use of non-operative management for all patients over 75, irrespective of displacement

Question 8

Operative management

Answer 8

Tension band wiring (if fracture proximal to the coranoid process)

Olecranon plating (if at level of, or distal to, the coranoid process)

Question 9

Mechanism of olecranon bursitis

Answer 9

Repetitive flexion-extension movements at the elbow, causing irritation of the bursa.

Question 10

Clinical features of olecranon bursitis

Answer 10

Pain and swelling over the olecranon.
Small volume of swelling for with recent increases in size, discomfort, or erythema.

Normal ROM with minimal discomfort

Question 11

Ix for olecranon bursitis

Answer 11

Routine bloods - FBC and CRP, RF (if suspicion)
Serum urate levels - exclude gout
Xray
Aspiration - MC+S

Question 12

Managment

Answer 12

Not infected - conservative:

• analgesia - NSAIDS
• Rest
• splinting for short time may be required
• washout if large

Infection:

• IV abx
• surgical drainage

Question 13

Complications of olecranon bursitis

Answer 13

Most cases will resolve spontaneously.

Rarely, septic arthritis or osteomyelitis can develop in infective cases