Olecranon fracture

1. Olecran
on
Fractur
e
By: Shalini Devani

2. Introduction:
•Olecranon fracture is a fracture involving the olecranon
process (proximal end) of the ulna bone.
•This process forms a part of the elbow joint that articulates
with the trochlea of the humerus bone.
•The olecranon is the proximal bony projection of the ulna at
the elbow.
•It may be associated with coronoid fracture as well as Elbow
fractures/dislocations.

3. Patho-anatomy :
Proximal fragment may be pulled by the attached Triceps
muscle , thus creating a gap at the # site.
The olecranon is the proximal bony projection of the ulna at the
elbow. Olecranon fractures are a diverse group of injuries, ranging
from simple nondisplaced fractures to complex fracture
dislocations of the elbow joint.
–Depending on the forces acting, Olecranon # can be
classified as.. :

4. Types :
(1)Intra or Extra-articular
–Intra: associated with joint effusions & hematoma
–Extra: mostly avulsion type; common in adults.
(2)Displaced or Undisplaced
–Displaced: >2 mm distance between fracture fragment
(3)Transverse/Oblique/ Comminuted/ Stable/Unstable
–Stable: fragments are not separate or if separation degree
does not increase with flexion to 90°

5. Mechanism Of Injury
•Being a subcutaneous structure, Olecranon is vulnerable
to direct trauma.
•Most common causes are:
–most common mechanism of an olecranon fracture is a
fall on the semiflexed supinated forearm
–Next is, direct trauma, as in falls on, or blows to, the
point of the elbow
•Occasionally, by hyperextension injuries, such as those
resulting in elbow dislocation in adults or supracondylar
fractures in children.
•Very rarely, broken by muscular violence, as in throwing

6. Diagnosis:
•Symptoms include
history of trauma is present
pain and swelling in and around the elbow joint
tenderness is present at the fracture site
Crepitus or a gap may be present between the fragments
TESTS: to check...
disruption of extensor mechanism, patient should be asked to
attempt extension against gravity.
Unstable fracture is confirmed by inability to extend the
elbow.
Stability of elbow (+MCL) after operative fixation:
varus+valgus stree in full extension & moderate flexion.

7. Radiolodical diagnosis:
•X-ray confirms the
diagnosis.
•They show the fracture
and help in it's
classification

8. Treatment GOALS:
•In young active
individuals,
–restoration of the
articular surface,
–preservation of motor
power,
–restoration of stability,
–prevention of joint
stiffness
•In older patients,
–minimization of
morbidity

9. Treatment:
•Depends on the type:
–Nondisplaced fractures with intact extensor
mechanisms may be treated nonoperatively. Three
weeks of casting usually is sufficient

10. •Fractures with significant displacement (>2 mm) or
comminution may require surgical intervention.
–Excision and triceps advancement may be indicated for
severely comminuted fractures or for patients with
osteoporotic bone.
–ORIF - for displaced intra- articular fractures.
•Intramedullary screw fixation, with or without a wire or
cable, is the most secure.
•Plate fixation
– for extensive comminuted or unstable oblique
fractures not amenable to other types of treatment.
–for an associated coronoid fracture

11. K-wire/
Tension-band
wiring

12. {AP view
radiograph
following ORIF
of the fracture
with a 7.3-mm
cannulated screw
and 1.6-mm
cable}
{Lateral
radiograph
demonstrating
the threads of
the screw
engaging the
cortices of the
ulna.}
S
C
R
E
W

13. Plating

14. Complications..
loss of some movement of the elbow joint
non union of the fracture (treated by ORIF + BG)n
arthritis of the elbow joint
Symptomatic hardware requiring removal is the most frequent
complication following internal fixation (k-wire>>nail/plate)c
Myositis ossificans
Other rare Complications might include Infection, Reflex
Sympathetic Dystrophy,etc.


15. Prognosis
•Evaluation criteria:
–degree of pain,
–range of motion,
–radiographic findings.
•Best outcome: patients who have non displaced or
minimally displaced fractures treated non operatively
•TBW << Plate-fixation {good results}

16. Thank-You