olecranon fracture

OLECRANON FRACTURE

Wafer Aldulaimi / Denmark

Anatomy

The olecranon and the proc. coronoideus form the Incisura trochlearis , which articulates with the trochlea of the distal humerus.

The intrinsic anatomy of this articulation allows for flexion/extension movement of the elbow joint and provides for stability of the elbow.

Epidemiology

Bimodal distribution.high energy injuries in youngsecondary to falls in the elderly

Very rare in children. The same trauma will

cause distal humeral fracture instead.

 Mechanismof injury 

Direct blow A fall on an outstretched hand with the elbow in

flexion Sudden and violent triceps muscle contraction

can produce an avulsion fracture of varying size of the olecranon tip

Evaluation 

History Physical examination Imaging

Plain radiographs are usually sufficient for isolated fractures of the olecranon.

CT : may be useful for preoperative planning in comminuted fractures.

Classification 

The Mayo classification

Colton Classification

Nondisplaced - Displacement does not increase with elbow flexion

Avulsion (displaced) Oblique and Transverse (displaced) Comminuted (displaced) Fracture dislocation

Schatzker Classification

AO Classifiation

Type A: extraarticular Type B: Intraarticular Type C: Intra-articular fractures of both the radial

head and olecranon

Treatment 

Goals: Articular restoration Preservation of the extensor mechanism Elbow stability Avoidance of stiffness and maintain the range of

motion

Nonsurgical:

Nondisplaced fractures (< 2mm dislocation) can be effectively treated by immobilization of the limb in a long-arm splint or cast with the elbow flexed at 45-90° for 4 weeks.

Displaced fracture is low demand, elderly individuals

Contraindications include active infection and severe medical comorbidities.

Surgical procedures 

Tension band wiring technique over two Kirschner wires

Contoured plate application to the posterior aspect of the proximal ulna

Intramedullary fixation

Fragment excision and triceps reattachment

Complication

Symptomatic hardware most frequent reported complication

Stiffness occurs in ~50% of patients ,usually doesn't alter functional capabilities

Heterotopic ossification more common with associated head injury

Posttraumatic arthritis Nonunion rare (5%) Ulnar nerve symptoms Anterior interosseous nerve injury Loss of extension strength

Tension band technique

Fracture reduction

Drilling

Wire preparation and insertion

First K-wire insertion

Second K-wire

Figure-of-eight configuration

Tightening the wire

Prevent later soft-tissue irritation

Sinking the K-wires

The end result

References: AO Principles of Fracture Management: Thomas P. Ruedi , William M. Murphy Rockwood and Green's Fractures in Adults AAOS