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Olecranon Fracture

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Other Names

  • Triceps Avulsion Fracture
  • Elbow Fracture

Background

Epidemiology

  • Represent ~10% of elbow fractures (need citation)
  • Bimodal (need citation)
    • Young males with high energy mechanism
    • Adult females with low energy mechanism

Pathophysiology

Etiology

  • Universally traumatic
    • Direct blow involving fall directly onto posterior elbow
    • Fall in out stretched upper extremity
    • Less commonly, eccentric contraction of Triceps Brachii on partially flexed elbow

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Exam Elbow
  • History
    • Description of trauma
    • Posterior elbow pain
  • Physical Exam
    • Palpable tenderness, defect
    • Inability to extend elbow, may indicate loss of extensor mechanism

Evaluation

  • Radiographs
    • Standard 3 view elbow typically sufficient
    • Lateral best view to evaluate fracture pattern
    • Consider radiocapitellar view
  • CT
    • Helpful for more clearly evaluating joint especially if complex or comminuted
    • Useful in preoperative planning

Classification

Mayo Classification

  • Type I: Undisplaced[1]
  • Type II: Displaced
    • A: Noncomminuted
    • B: Comminuted
  • Type III: Unstable
    • A: Noncomminuted
    • B: Comminuted

Colton Classification

  • Nondisplaced: Displacement does not increase with elbow flexion
  • Avulsion (displaced)
  • Oblique and Transverse (displaced)
  • Comminuted (displaced)
  • Fracture dislocation

Schatzker Classification

  • Type A: Simple transverse fracture
  • Type B: Transverse impacted fracture
  • Type C: Oblique fracture
  • Type D: Comminuted fracture
  • Type E: More distal fracture, extra-articular
  • Type F: Fracture-dislocation

AO Classification

  • Type A: Extra-articular
  • Type B: Intra-articular
  • Type C: Intra-articular fractures of both the radial head and olecranon

Management

Nonoperative

  • Indications
    • Nondisplaced
    • Minimally displaced in elderly, low demand patients
  • Immobilization
    • Acute: Posterior Long Arm Splint with elbow flexed to 90°
    • Subacute: Prefab removable splint to help minimize loss of ROM
    • Begin rehabilitation early to minimize capsulitis or loss of range of motion
    • Active motion against resistance typically doesnt occur until 8-10 weeks with callous formation[2]

Operative

  • Indications
    • Displaced fracture
    • Transverse fracture
    • Comminuted
    • Monteggia
    • Fracture-dislocation
    • Oblique fractures
  • Technique
    • Tension band
    • IM Fixation
    • Plate and screw

Return to Play

  • Highly variable
  • Surgeon discretion

Complications


See Also


References


  1. https://www.orthobullets.com/trauma/1022/olecranon-fractures
  2. Veillette, C. J. H., & Steinmann, S. P. (2008). Olecranon Fractures. Orthopedic Clinics of North America, 39(2), 229–236. doi:10.1016/j.ocl.2008.01.002
Created by:
John Kiel on 18 June 2019 01:12:29
Authors:
Last edited:
11 November 2020 14:27:14
Categories:
Trauma | Elbow | Upper Extremity | Fractures | Acute