Olecranon Fracture: Diagnosis and Treatment
Olecranon fracture is a fracture involving the olecranon process of the ulna bone. This process forms a part of the elbow joint that articulates with the trochlea of the humerus bone.
Before reading further please review the Elbow Joint Anatomy to get a better understanding (skip if you have already done so).
This fracture occurs in two ways
- fall on the tip of the elbow joint
- sudden forceful contraction of the triceps muscle (the muscle pulls the bone fragment apart)
- history of trauma is present
- pain and swelling in and around the elbow joint
- inability to extend the elbow against gravity
- tenderness is present at the fracture site
Diagnosis is confirmed by x rays. They show the fracture and help in it's classification.
Classification of olecranon fracture is into two main types that are
- Undisplaced and stable fractures (also called hair line fractures; gap between fracture fragments less than 2mm; active extension is possible against gravity)
- Displaced fractures (fracture fragments are separated from each other; active extension against gravity is not possible)
All undisplaced fractures are treated by immobilization in a plaster splint for 3 weeks. The elbow should immobilized at 45 degrees of flexion. After 7 to 10 days of immobilization a x ray is done to confirm the position of the fracture.
After three weeks the splint is removed and a brace is worn. This brace should prevent movement of the elbow beyond 90 degrees.
Complete healing takes about 6 to 8 weeks after which movement beyond 90 degrees is allowed.
In elderly patients (beyond 60 years) the elbow is rested in a sling. A mild crepe bandage is wrapped gently around the elbow and pain killer are given. Once pain has decreased, gentle movements are encouraged in a brace. After the fracture has united the brace is removed.
All displaced fractures are treated operatively by fixation with wires, screws or plates. The fixation should be strong enough for early active mobilization of the elbow joint. This prevents the elbow from becoming stiff.
- loss of some movement of the elbow joint
- non union of the fracture
- arthritis of the elbow joint
This is a x ray of a olecranon fracture that is displaced. You can see the gap between the fragments. The fracture occurred after a fall, with tip of the elbow striking the ground.
Same fracture after surgical treatment, with tension band wiring.
This x ray shows a extra-articular fracture of the olecranon. It is extra-articular because it does not involve the elbow joint cartilage. The young male who had this fracture could not extend his elbow against gravity.
During surgery a tear in the triceps tendon was found. The tendon was repaired with suture and the fracture was fixed with a screw. Below is the post operative x ray.
Frequently Asked Questions
When can I suspect that I have a olecranon fracture?
If after trauma you are unable to extend your elbow against gravity then you probably have a olecranon fracture.
Will I gain complete movement of the elbow joint after this fracture?
Young patients below the age of 25 years can expect to regain full movement of the elbow joint when
- the fracture is undisplaced
- fracture hasn't multiple bone fragments
- active movements are started early after operation
Otherwise some loss of movement is usually inevitable.
How can I prevent the development of arthritis?
Accurate reduction of the bone fragments without any step off can prevent arthritis. Ask your doctor if the bone fragments have been aligned perfectly.
How does non union occur and what is it's treatment?
Non union can occur when
- undisplaced fracture becomes displaced and goes unrecognised
- there are multiple fracture fragments
- fixation of the fracture after operation is not rigid enough
- active forceful use of the limb before adequate union
- old age and poor health
Treatment of non union is by rigid fixation of the fracture along with bone grafting.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 28th August 2011.
Other causes of elbow pain...
Radial Head Fracture
Little League Elbow
Lateral Condyle Fracture
Elbow Joint Anatomy
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