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Olecranon fracture

Dr Yuranga Weerakkody ◉ and A.Prof Frank Gaillard ◉ ◈ et al.

Olecranon fractures are clinically and radiographically obvious, and usually require open reduction and internal fixation.

On this page:

Article:

Mechanism
Radiographic features
Reporting checklist
Treatment and prognosis
Differential diagnosis
Related articles
References

Images:

Cases and figures

Mechanism

Olecranon fractures occur as the result of one of four mechanisms ²:

direct blow (or fall directly on the elbow)
fall on outstretched hand with elbow flexed
avulsion fracture - e.g. triceps bony avulsion
stress fracture, e.g. throwing athletes and gymnasts

It is important to remember that the ulnar nerve is closely related to the medial aspect of the olecranon and, although not common, nerve injury may complicate these fractures ².

Radiographic features

Plain radiograph

Olecranon fractures are easy to diagnose provided a lateral x-ray of the elbow is obtained. They appear as a lucency usually reaching the trochlear groove articular surface and are, in most cases, displaced.

Reporting checklist

Radiology reports should not only include whether or not a fracture is present but also comment on:

fracture
- location, especially whether or not it reaches the articular surface
- displacement and the gap distance
- comminution
associated findings and relevant negatives
- presence of fracture of the coronoid process
- presence of fracture or dislocation of the radial head
- presence of fracture of the distal humerus

Treatment and prognosis

Due to the unopposed traction of the triceps muscle, these fractures are usually widely displaced and require open reduction and internal fixation (ORIF) ¹. Occasionally when undisplaced non-operative treatment with immobilization at 30 degrees of flexion is possible ². Union rates with appropriate treatment are very high (~99%) and other than a slight reduction in flexion and extension at the elbow, function is preserved ^1,2.

Unlike many other intra-articular fractures, olecranon fractures result in relatively little secondary osteoarthritic changes, probably on account of most fractures occurring through a relatively non-articular part of the trochlear groove ¹.

Most of the symptoms relate to prominence of hardware given the little overlying soft tissues ¹.

Occasionally ulnar nerve injury can result in long-term sensory and motor impairment, most marked in the hand.

Differential diagnosis

There is usually little differential, especially in adults, and when the clinical presentation is that of trauma to the elbow with pain, swelling and lack of mobility. In young patients, one must consider unfused olecranon epiphysis ³. Extremely rarely it can mimic a patella cubiti.

References

Fractures

fracture
- terminology
  - fracture location
    - diaphyseal fracture
    - metaphyseal fracture
    - physeal fracture
      - Salter-Harris classification
        
        type I
        
        type II
        
        type III
        
        type IV
        
        type V
    - epiphyseal fracture
  - fracture types
  - fracture displacement
    - fracture translation
      - off-ended fracture
    - fracture angulation
    - fracture rotation
    - fracture length
      - distraction
      - impaction
      - shortening
- skull fractures
  - base of skull fractures
    - occipital condyle fracture
    - temporal bone fractures
      transsphenoidal basilar skull fracture
  - skull vault fractures
    - depressed skull fracture
    - ping pong skull fracture
- facial fractures
  - fractures involving a single facial buttress
    - alveolar process fractures
    - frontal sinus fracture
    - isolated zygomatic arch fractures
    - mandibular fracture
    - nasal bone fracture
    - orbital blow-out fracture
    - paranasal sinus fractures
  - complex fractures
- spinal fractures
  - classification (AO Spine classification systems)
    - cervical spine fracture classification systems
      - AO classification of upper cervical injuries
      - AO classification of subaxial injuries
      - Anderson and D'Alonzo classification (odontoid fracture)
      - Levine and Edwards classification (hangman fracture)
      - Roy-Camille classification (odontoid process fracture )
      - Allen and Ferguson classification (subaxial spine injuries)
      - subaxial cervical spine injury classification (SLIC)
    - thoracolumbar spinal fracture classification systems
    - three column concept of spinal fractures (Denis classification)
    - classification of sacral fractures
      - AO classification of sacral injuries
  - spinal fractures by region
    - cervical spine fractures
    - thoracic spine fractures
    - lumbar spine fractures
  - spinal fracture types
- rib fractures
  - flail chest
  - stove-in chest
- sternal fractures
- upper limb fractures
  - classification
  - upper limb fractures by region
    - shoulder
      - clavicular fracture
      - scapular fracture
        
        acromion fracture
        
        coracoid process fracture
        
        glenoid fracture
        
        Bankart lesion
        
        reverse Bankart lesion
      - humeral head fracture
        
        Hill-Sachs lesion
        
        reverse Hill-Sachs lesion
      - proximal humeral fracture
      - humeral neck fracture
    - arm
      - humeral shaft fracture
    - elbow
    - forearm
      - forearm fracture-dislocation
        
        Essex-Lopresti fracture-dislocation
        
        Galeazzi fracture-dislocation
        
        Monteggia fracture-dislocation
      - forearm fracture
        nightstick fracture
    - wrist
      - distal radial fracture
        
        Chauffeur fracture
        
        Colles fracture
        
        Smith fracture
        
        Barton fracture
        
        reverse Barton fracture
      - distal ulnar fracture
        ulnar styloid fracture
    - carpal bones
      - scaphoid fracture
        
        scaphoid non-union
        scaphoid non-union advanced collapse
        
        humpback deformity
      - lunate fracture
        
        perilunate fracture-dislocation
        
        lunate dislocation
      - capitate fracture
      - triquetral fracture
      - pisiform fracture
      - hamate fracture
        hook of hamate fracture
      - trapezoid fracture
      - trapezium fracture
    - hand
- lower limb fractures
  - classification by region
    - pelvis
      - Judet and Letournel classification (acetabular fracture)
      - Young and Burgess classification of pelvic ring fractures
    - hip
    - femoral
      - Winquist classification (femoral shaft fracture)
    - knee
      - Schatzker classification (tibial plateau fracture)
      - Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture)
    - tibia/fibula
      - Watson-Jones classification (tibial tuberosity avulsion fracture)
    - ankle
      - Lauge-Hansen classification (ankle injury)
      - Danis-Weber classification (ankle fracture)
    - foot
      - Berndt and Harty classification (osteochondral lesions of the talus)
      - Sanders CT classification (calcaneal fracture)
      - Hawkins classification (talar neck fracture)
      - Myerson classification (Lisfranc injury)
      - Nunley-Vertullo classification (Lisfranc injury)
  - pelvis and lower limb fractures by region
    - pelvic fracture
    - sacral fracture
      - sacral insufficiency fractures
        Honda sign
    - coccygeal fracture
    - hip
      - acetabular fracture
      - femoral head fracture
      - femoral neck fracture
        
        subcapital fracture
        
        transcervical fracture
        
        basicervical fracture
      - trochanteric fracture
        
        pertrochanteric fracture
        
        intertrochanteric fracture
        
        subtrochanteric fracture
    - thigh
      - mid-shaft fracture
      - bisphosphonate-related fracture
    - knee
      - avulsion fractures
        
        Segond fracture
        
        reverse Segond fracture
        
        anterior cruciate ligament avulsion fracture
        
        posterior cruciate ligament avulsion fracture
        
        arcuate complex avulsion fracture (arcuate sign)
        
        biceps femoris avulsion fracture
        
        iliotibial band avulsion fracture
        
        semimembranosus tendon avulsion fracture
        
        Stieda fracture (MCL avulsion fracture)
      - patellar fracture
      - tibial plateau fracture
    - leg
      - tibial tuberosity avulsion fracture
      - tibial shaft fracture
      - fibular shaft fracture
      - Maisonneuve fracture
    - ankle
      - bimalleolar fracture
      - trimalleolar fracture
      - triplane fracture
      - Tillaux fracture
      - Bosworth fracture
      - pilon fracture
      - Wagstaffe-Le Fort fracture
    - foot
      - tarsal bones
        
        Chopart fracture
        
        calcaneal fracture
        
        lover's fracture
        
        calcaneal tuberosity avulsion fracture
        
        talus fracture
        
        talar body fractures
        
        talar dome osteochondral fracture
        
        posterior talar process fracture
        
        lateral talar process fracture
        
        talar neck fracture
        aviator fracture
        
        talar head fracture
        
        navicular fracture
        
        medial cuneiform fracture
        
        intermediate cuneiform fracture
        
        lateral cuneiform fracture
        
        cuboid fracture
        nutcracker fracture
      - metatarsal bones
        
        general
        
        march fracture
        
        Lisfranc fracture-dislocation
        
        5th metatarsal fracture
        
        stress fracture of the 5th metatarsal
        
        Jones fracture
        
        pseudo-Jones fracture
        
        avulsion fracture of the proximal 5th metatarsal
      - phalanges

Article information

rID: 18072

System: Musculoskeletal, Trauma

Tag: trauma, emergencymedicine

Synonyms or Alternate Spellings:

Olecranon fracture
Fracture of the olecranon
Fractures of the olecranon

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Cases and figures

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Case 2: with ORIFCase 2: with ORIF

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Case 5Case 5

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