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Fractures of the Olecranon

- 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

- Non Operative Treatment:
     - ref: Nonoperative Management of Displaced Olecranon Fractures in Low-Demand Elderly Patients

- Operative Treatment:
     - surgical approach:
     - tension band wiring:

           - contra-indicated w/ olecranon frx which are distal to the midpoint of the trochlear notch;
                  - ref: Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation.
     - plate fixation:

     - 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);
           - ref: Operative treatment of olecranon fractures. Excision or open reduction with internal fixation.


- Complications:
    - painful hardware (most patients will require removal of hardware once the frx has healed);
           - Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience
    - ulnar nerve paresthesia;
    - non-union;
            - Treatment of nonunion of olecranon fractures.
            - Operative Treatment of Olecranon Nonunion.  
    - loss of extension (10-15 deg)
    - ectopic bone is seen occasionally

Displaced olecranon fractures in adults. Clinical evaluation.

Some vagaries of the olecranon.

Olecranon stress fractures in throwers. A report of two cases and a review of the literature.

Olecranon fractures: a review of 100 cases.    

Contribution of the Olecranon to Elbow Stability: An in Vitro Biomechanical Study

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