Olecranon fractures usually occur as isolated injuries, but they are occasionally found in the polytrauma patient.
Classification
AO Classification
extra-articular (21-A),
articular and involving the surface of one bone (21-B),
articular and involving the surface of both bones (21-C).
Aetiology
Direct or indirect forces or combination
Direct forces
drive the olecranon into the distal humerus
producing comminuted fractures with depressed joint fragments, similar to a tibial plateau fracture.
Indirect
indirectly through the contraction of the triceps muscle
transverse or short oblique fracture patterns.
Pathology
History
Mechanism of Injury
Examination
painful, swollen elbow,
in displaced fractures – a palpable defect
Crepitus with elbow motion
The inability to extend the elbow against gravity suggests loss of the integrity of the elbow extensor mechanism.
Neurovascular evaluation – particular attention to the ulnar nerve.
The proximity of the ulnar nerve places it at risk for injury, especially when direct forces are involved in the accident.
Investigations
Xrays
anteroposterior (AP) view
true lateral view
Treatment
Aim
reconstruction of the articular surface,
restoration of the elbow extensor mechanism,
preservation of elbow motion and function
prevention or avoidance of complications
Nonoperative
Indications
nondisplaced fractures,
injuries where the elbow extensor mechanism is intact with poor overall medical condition of the patient
Operative
Indications
displaced fractures
injuries with elbow extensor-mechanism disruption
open fractures.
Options:
open reduction and internal fixation (ORIF)
fragment excision with elbow extensor-mechanism reconstruction
Tips
steps may help avoid symptoms related to the implants.
K wires are over-inserted 1 cm and then backed up to ease deep final seating.
K wires are bent 180 degrees before final seating so that the bent portion of the wire penetrates the tip of the olecranon, making the wires less prominent.
K wires that engage the anterior cortex may prevent the wires from backing out
The figure-of-eight wire knots should be buried in the surrounding muscle to avoid their prominence.
