Olecranon fractures are clinically and radiographically obvious, and usually require open reduction and internal fixation.
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
- 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 as such injury is possible, although not common 2.
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.
Radiology reports should not only include whether or not a fracture is present but also comment on:
- associated findings and relevant negatives
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 then non-operative treatment with immobilisation at 30 degrees of flexion is possible 2. Union rates with appropriate treatment are very high (~99%) and other than 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 though 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.
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.
- elbow anatomy
- elbow radiography
- MRI of the elbow - an approach
- distal humeral fracture
- Panner disease (osteochondrosis of the capitellum)
- 1. Stannard JP, Schmidt AH, Kregor PJ. Surgical Treatment of Orthopaedic Trauma. Thieme Medical Pub. (2007) ISBN:1588903079. Read it at Google Books - Find it at Amazon
- 2. Greenberg MI. Greenberg's text-atlas of emergency medicine. Philadelphia : Lippincott Williams & Wilkins, c2005. (2005) ISBN:0781745861. Read it at Google Books - Find it at Amazon
- 3. Pavlov H, Torg JS, Jacobs B et-al. Nonunion of olecranon epiphysis: two cases in adolescent baseball pitchers. AJR Am J Roentgenol. 1981;136 (4): 819-20. AJR Am J Roentgenol (citation) - Pubmed citation