- 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:
- Operative Treatment:
-
surgical approach:
-
tension band wiring:
- contra-indicated w/ olecranon frx which are distal to the midpoint
of the trochlear notch;
-
plate fixation:
- if frx extends distally past midpoint of trochlear notch, it no
longer represents only a disruption of the
triceps
mechanism but also comprimises the stability of elbow in withstanding varus &
valgus forces;
- in this case, plate fixation is required;
- note that in the study by Hume-M-C. Wiss-D-A. (CORR 1992),
plate fixation yielded significantly
better clinical results than TBW;
- ref:
Olecranon fractures. A clinical and radiographic comparison of tension
band wiring and plate fixation.
-
comminuted olecranon fractures are another indication for plate fixation;
- associated
coronoid process fracture
- coronoid
fracture is exposed by reflexion of the
olecranon fracture and attached triceps proximally;
- direct exposure is achieved working through the fracture
site;
- coronoid is stabilized with w/ screws w/ the heads screwed
down to the level of the fracture site;
- the main olecranon fracture is then reflected back down,
reduced and fixed in the usual manner;
-
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);
- Complications::
- painful hardware (most patients will require removal of hardware once the
frx has healed);
- ulnar nerve paresthesia;
- non-union;
- loss of extension (10-15 deg)
- ectopic bone is seen occasionally;