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Pediatric Olecranon Fracture

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Other Names

  • Elbow Fracture

Background

  • Refers to fracture of the Olecranon of the proximal Ulna in children

Epidemiology

  • Uncommon fracture pattern in children
  • Represent approximately 5% of elbow fractures in children[1]
  • Occurs most commonly between ages 5-10[2]
  • 65% male

Pathophysiology

  • Mechanism typically involves fall on outstreched arm
    • Flexed elbow with contracting Triceps Brachii, Brachialis may lead to avulsion fracture (less common in children)
    • Extended elbow
    • Direct trauma
  • Stress fracture can occur from overuse injury and be subacute
  • Types
    • Short, oblique
    • Transverse

Pathoanatomy

  • Location
    • Metaphyseal (most common)
    • Physeal
    • Epiphyseal
      • Intra-articular
      • Extra-articular

Ossification Centers of the Elbow

Ossification center Age of Appearance on Xray Age of fusion
Capitellum 1 12
Radial Head 3 15
Medial Epicondyle 5 17
Trochlea 7 12
Olecranon 9 15
Lateral Epicondyle 11 12

Associated Injuries


Risk Factors


Differential Diagnosis


Clinical Features

  • General: Physical Exam Elbow
  • History
    • Patient will endorse trauma
    • Reports pain, swelling, bruising, inability to flex or extend elbow
  • Physical
    • Inspect for swelling, bruising
    • Loss of range of motion

Evaluation

Lateral view showing olecranon fracture with migration of proximal fragment

Radiographs

  • Standard Radiographs Elbow
    • Standard elbow radiographs usually sufficient
    • May see lucency usually reaching the trochlear groove articular surface

Classification

  • N/A

Management

Nonoperative

  • Indications
    • Stress fracture or reactions
    • Apophysitis
    • Minimally displaced fractures, typically <2 mm
  • Immobilization in Long Arm Cast for acute injuries
  • NSAIDS
  • Relative rest
  • Avoidance of provocative activities
  • Physical Therapy

Operative

  • Indications
    • Displaced fractures >2 mm
    • unstable or comminuted

Return to Play

  • Variable
  • For overuse injuries, graduated return to play

Complications


See Also


References


  1. Landin LA, Danielsson LG. Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand. 1986;57(4):309–12.
  2. Erickson M, Frick S. Fractures involving the proximal radius and ulna. In: Rockwood CA, Wilkins KE, King RE, editors. Rockwood and Wilkins fractures in children. 7th ed. Philadelphia: J.B. Lippincott. p. 427–42. Section 2 Ch. 11.
  3. Evans MC, Graham KH. Olecranon fractures in children: part 1: a clinical review, part 2: a new classification and management algorithm. J Pediatr Orthop. 1999;19(5):559–69.
Created by:
John Kiel on 18 June 2019 01:16:43
Authors:
Last edited:
30 November 2021 01:36:06
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