Fractures of the Olecranon - Wheeless' Textbook of Orthopaedics

- See:
- Pediatric Frx of the Olecranon
- Radial Head Fractures:

- Discussion:
- low energy olecranon fractures:
- most commonly occur in elderly patients, and result from indirect trauma;
- fracture and results from a sudden pull of both the triceps and brachialis muscles;
- frx begins at midpoint of trochlear notch and extends distally to enter semilunar notch;
- amount of frx displacement is influenced by the pull of the triceps muscle as
well as any disruption of triceps aponeurosis or periosteum;
- high energy fractures:
- olecranon fractures in younger patients are more often high energy injuries, resulting from direct trauma;
- often there is associated comminution or concomitant ulnar shaft frx;
- anatomy of olecranon:

- Physical Exam:
- because all frx of the olecranon process have some intra-articular component, there is generally a hemorrhagic effusion of elbow joint;
- this results in pain and swelling over the olecranon;
- inability to extend the elbow actively against gravity is a key finding;
- it indicates the discontinuity of the triceps mechanism;
- the presence or absence of this sign determines the plan of Rx:

- Radiographs for Olecranon Frx:

- Operative Treatment:
- surgical approach:
- tension band wiring:
- contra-indicated w/ olecranon frx which are distal to the midpoint of the trochlear notch;
- plate fixation:
- if frx extends distally past midpoint of trochlear notch, it no longer represents only a disruption of the triceps
mechanism but also comprimises the stability of elbow in withstanding varus & valgus forces;
- in this case, plate fixation is required;
- note that in the study by Hume-M-C. Wiss-D-A. (CORR 1992), plate fixation yielded significantly better clinical results than TBW;
- ref: Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation.
- comminuted olecranon fractures are another indication for plate fixation;
- excision of olecranon:
- resection of proximal fragment & reattachment of triceps is reserved for elderly patients w/ osteoporotic bone;
- frx must be proximal to middle of the trochlear notch or involve < 50% of articluar surface (otherwise the elbow will be unstable);

- Complications:
- painful hardware (most patients will require removal of hardware once the frx has healed);
- ulnar nerve paresthesia;
- non-union;
- loss of extension (10-15 deg)
- ectopic bone is seen occasionally;