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1. Fracture of the Olecranon Process By Luv Saxena Simran Aswal Sahil Monga

2. Epidemiology Bimodal Distribution -Younger individuals : High-energy trauma - Older individuals : Simple falls 2

3. Anatomy 3

4. Anatomy Location and Structure : The olecranon is the part of the ulna that cups the lower end of the humerus, creating a hinge for elbow movement. The bony point of the olecranon can easily be felt beneath the skin because it is covered by just a thin layer of tissue. It is shaped like a hook or curved beak and projects upward behind the elbow joint. 4

5. Anatomy The superior aspect of the olecranon is roughened, providing a surface for muscle and tendon attachment. The anterior surface of the olecranon forms part of the trochlear notch , a deep concave depression that articulates with the trochlea of the humerus. This articulation is crucial for the hinge movement of the elbow joint, allowing for flexion and extension of the forearm . 5

6. Muscle Attachments The olecranon serves as a critical site for muscle attachment: Triceps Brachii Muscle : This muscle, located on the back of the upper arm, inserts into the superior aspect of the olecranon via the triceps tendon. The triceps brachii is the primary extensor muscle of the elbow, and its contraction pulls on the olecranon to straighten the arm. Anconeus Muscle : This small triangular muscle attaches to the lateral aspect of the olecranon. It assists the triceps in extending the elbow and stabilizing the elbow joint. 6

7. Mechanism of Injury Direct : Fall on the point of elbow or direct trauma to olecranon - Typically results in a comminuted olecranon fracture. Indirect : Fall onto the outstretched upper extremity accompanied by a strong, sudden contraction of triceps. - Typically results in a transverse or oblique fracture. A combination of these may produce displaced , comminuted fractures or in case of extreme violence, fracture-dislocation with anterior displacement of the distal ulnar fragment and radial head. 7

8. Classification The Mayo classification system accounts for fracture displacement and elbow stability, being divided into three types. These characteristics allow for a good indication of treatment and prognosis. 8

9. Mayo Classification 9 Type I type IA:   undisplaced non- comminuted type IB:   undisplaced comminuted Type II type IIA:  displaced non- comminuted type IIB:  displaced comminuted Type III type IIIA:  unstable non- comminuted type IIIB:  unstable comminuted

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11. Diagnosis Medical History and Symptoms: The patient may report pain, swelling, and difficulty extending the elbow. A history of trauma or injury to the elbow can be significant. Physical Examination: The physician will assess the elbow for swelling, tenderness, deformity, and range of motion. Palpation of the olecranon process may reveal localized tenderness. 11

12. Diagnosis Imaging: X-rays are the primary diagnostic tool. They can show the presence and extent of the fracture. In some cases, CT scans might be used for more detailed visualization, especially if the fracture is complex or involves joint involvement. Functional Assessment: Evaluating the patient’s ability to extend the elbow and any potential impact on joint function can help in assessing the severity of the injury. 12

13. Clinical Evaluation 13

14. Radiographic Evaluation 14

15. Radiographic Evaluation 15

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17. Radiographic Evaluation 17