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Comminuted Fractures of Olecranon

- See:
      - Avulsion Fracture
      - Comminuted Fractures
      - Excision of Olecranon:
      - Fracture Dislocations
      - Oblique Fractures
      - Radial Head Fractures:
      - Surgical Approach:
      - Transverse Fractures

- Discussion:
    - result from high velocity injury, such as from a fall or from direct blow;
    - there are multiple frx planes, often w/ severe crushing of many frags;
    - there may be assoc frx of distal end of humerus, shafts of forearm bones, or the head of the radius;
    - reduction of this frx should begin distally and proceed toward joint;
    - if there is butterfly frag distal to the coronoid process, attempt is be made to reduce it and fix it w/lag screw before one proceeds w/ the 
           reduction of the joint surface;
    - articular surface of the distal fragment must be clearly visualized;

- Subtypes:
    - Frx of the Coronoid Process + Olecranon;
    - Distal Olecranon Fracture:
    - Radial Head Fractures + Olecranon Frx:
         - assoc frx of radial head signifies dislocation of elbow and is usually assoc w/ disruption of MCL;
         - radial head has to be reduced & fixed or replaced by prosthesis;

- Treatment:
    - - surgical approach:
    - plate fixation
    - isolated comminuted fractures
           - w/ frx comminution, it is important to align the fracture by aligning the cortex instead of the articular surface, noting that the sigmoid notch is typically
                 devoid of cartilage in its mid section (the effect of which would be narrowing of the notch); 
       - see: anatomy of olecranon;
           - frxs w/o elbow dislocation and w/o disruption of anterior soft tissues) may be  treated by excision of olecranon and reattachment of triceps;
                 - it is important to retain the collateral ligaments, esp anteromedial portion for stability (allows early motion)

Comminuted fractures of the olecranon. Management by bone graft from the iliac crest and multiple tension-band wiring.