Olecranon fracture
This page is for adult patients. For pediatric patients, see: olecranon fracture (peds)
Background
- Occurs via direct trauma or by fall with forced hyperextension of elbow
- Common in high energy mechanism in young and falls in elderly
- Associated injuries are common:
- Dislocations, radial head fracture, ulnar nerve injury
Clinical Features
- Pain, swelling, and occasionally over posterior elbow
- Assess extensor mechanism by assessing elbow extension against resistance
- Forearm extension strength is reduced (triceps inserts at the olecranon)
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- AP lateral, requires true lateral
- Radiocapitellar view helps visualize radial head fracture, capitellar shear fracture
- CT can assist with operative planning
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Rule-out ulnar nerve injury
- Immobilize with long arm posterior mold with elbow in flexion and forearm neutral
- Refer to ortho within 24hr
- Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks
See Also
References
- Orthobullets