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Olecranon Fracture
From WikiSM
Contents
Other Names
- Triceps Avulsion Fracture
- Elbow Fracture
Background
- Intra-articular fracture at the olecranon of the Ulna, which articulates with the distal Humerus to form the Humeroulnar Joint
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
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
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
- Pain, especially from hardware
- Sitffness/ loss of ROM
- Heterotopic Ossification
- Posttraumatic Arthritis
- Nonunion
- Malunion
- Ulnar Neuropathy
- AIN Nerve Injury
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ https://www.orthobullets.com/trauma/1022/olecranon-fractures
- ↑ 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