Olecranon Fracture 813.01

synonyms: elbow fracture, olecranon Fracture

Olecranon Fracture ICD-9

• 813.01(closed fracture of olecranon process of ulna)
• 813.11(open fracture of olecranon process of ulna)

Olecranon Fracture Etiology / Epidemiology / Natural History

• Common causes: MVA, falls directly onto posterior elbow

Olecranon Fracture Anatomy

• see also Elbow Anatomy.

Olecranon Fracture Clinical Evaluation

• Pain, swelling in elbow.
• Document NV exam.
• Document wrist evaluation.

Olecranon Fracture Xray / Diagnositc Tests

• A/P, lateral and oblique elbow films. Fracture is best visualized on lateral film.

Olecranon Fracture Classification / Treatment

• AO classification AO Classification old view
• Nondisplaced: sling immobilization followed by gentle ROM initiated within 10 days. Consider initially long arm casting for 4 weeks or ORIF depending of patient and fracture severity. Initially weekly xrays indicated to ensure fracture remains reduced.
• Displaced Young/high-demand: ORIF
• Displaced Elderly/low-demand: ORIF vs excision with triceps advancement.
• Stress Fracture: generally associated with throwning sports, baseball. Treatment: rest and temporary splinting. Consider electrical stimulation. ORIF indicated after failure of nonoperative treatment. (Ahmad CS, Clin Sports Med 2004;23:665).

Olecranon Fracture Associated Injuries / Differential Diagnosis

• Elbow dislocation
• Distal humerus fracture
• Radial head fracture
• Monteggia Fracture

Olecranon Fracture Complications

• Superficial wound infection
• Contracture
• Nonunion
• Hardware failure
• Malunion
• Painful hardware: (tension band wiring frequently requires removal) (Karlsson MK, JSES 2002;11:377).
• Ulnar nerve palsy

Olecranon Fracture Follow-up Care

• Post-op: Place in posterior splint in 50-70º of flexion. Encourage finger ROM.
• 10-14 Days: Wound check, remove staples. Evaluate reduction on xrays. Place in long-arm cast or removable posterior splint depending on fracture type and strength of fixation.
• 6 Weeks: Wound check, evaluate xrays for callus formation. Place in removable posterior splint and begin elbow ROM exercises.
• 3 Months: Evaluate xrays for fracture union. Begin gentle sport specific exercises depending on fracture union. Consider bone stimulator if union not evident on xrays.
• 6 Months: Evaluate xrays. Return to sport.
• 1Yr: Evaluate xrays. Evaluate xrays using elbow outcome measures. May consider hardware removalif hardware is painful.
• (Bailey CS, JOT 2001;15:542).
• (Karlsson MK, CORR 2002;403:205).

Olecranon Fracture Review References

• Egol KA and Koval KJ in Fractures in Adults, 6th ed, 2006
• Advanced Reconstruction-Elbow, AAOS 2007
• OKU Shoulder and Elbow 2