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Olecranon fracture

Contents

Definition

  • Olecranon fractures account for approximately 10% of upper extremity fractures1
  • There are 3 types of fractures
    • Type I
      • Nondisplaced
      • Accounts for 5-12% of olecranon fractures
    • Type II
      • Displaced at least 3mm, but collateral ligaments may still be intact
      • Most common 80-85% of olecranon fractures
    • Type III
      • Displaced and the ulnohumeral joint is unstable
      • This injury is a fracture-dislocation, collateral ligaments may be incompetent causing instability2
      • Accounts for 6% of olecranon fractures

Occurrence

  • Common injury in adults, susceptible to direct blow3

Cause

  • Acute and traumatic event such as fall on elbow
  • Avulsion fractures may also occur from eccentric contraction of the triceps tendon

Risk factors

  • 50 years of age or older (mean age is 57)
  • Males more likely to sustain an injury at a younger age

Development

  • Posttraumatic arthritis occurs in approximately 20% of cases and persistent malreduction >2mm of the articular surface is associated with this outcome4
  • In fractures with significant comminution, inadvertent malreduction by narrowing the greater sigmoid notch may further predispose the patient to arthritis5
  • A displaced fracture may interfere with the extensor mechanism resulting in loss of active elbow extension
    • The pull of the triceps is the key deforming cause
  • The ulnar nerve is at risk of involvement due to its position

Examination

  • If displaced there may be a palpable gap
  • Passive flexion and extension may be limited (capsular pattern)
  • Resisted extension is painful and weak
  • Tenderness

Prognosis

  • In general
    • Patients usually have a good functional outcome after treatment6
      • Approximately 10-15 degree loss of extension may occur, although this is usually not clinically significant
      • Long-term follow-up ranging 15-25 years reported good or excellent functional outcome in 96% of patients7
      • Fractures have a high rate of healing with a nonunion rate of approximately 1%8

Treatment

  • Type I
    • Immobilization – posterior splint in slight extension 45-90 degrees of flexion
      • Followed by progressive active range of motion exercises with avoidance of active extension https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492613/
    • Type II and III
      • Generally require surgery
      • Type II may be treated non-operative. They may lose full elbow extension due to disruption of the extensor mechanism but in some patients this is thought to be preferential to the risk of surgery

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3492613/
  2. https://pubmed.ncbi.nlm.nih.gov/19580179/
  3. https://www.ncbi.nlm.nih.gov/books/NBK537295/
  4. https://pubmed.ncbi.nlm.nih.gov/23428192/
  5. https://pubmed.ncbi.nlm.nih.gov/7797857/
  6. https://www.ncbi.nlm.nih.gov/books/NBK537295/
  7. https://pubmed.ncbi.nlm.nih.gov/12360028/
  8. https://pubmed.ncbi.nlm.nih.gov/8027154/