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Fractures of the Olecranon

- 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

- Non Operative Treatment:
     - ref: Nonoperative Management of Displaced Olecranon Fractures in Low-Demand Elderly Patients

- Operative Treatment:
   - surgical approach:
- tension band wiring:

- contra-indicated w/ olecranon frx which are distal to the midpoint of the trochlear notch;
- ref: Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation.
   - 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);
- ref: Operative treatment of olecranon fractures. Excision or open reduction with internal fixation.

- Complications:
- painful hardware (most patients will require removal of hardware once the frx has healed);
- Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience
    - ulnar nerve paresthesia;
- non-union;
- Treatment of nonunion of olecranon fractures.
- Operative Treatment of Olecranon Nonunion.
- loss of extension (10-15 deg)
- ectopic bone is seen occasionally

Displaced olecranon fractures in adults. Clinical evaluation.

Some vagaries of the olecranon.

Olecranon stress fractures in throwers. A report of two cases and a review of the literature.

Olecranon fractures: a review of 100 cases.

Contribution of the Olecranon to Elbow Stability: An in Vitro Biomechanical Study