Olecranon fracture

This page is for adult patients. For pediatric patients, see: olecranon fracture (peds)

Background

  • Occurs via direct trauma or by fall with forced hyperextension of elbow
  • Common in high energy mechanism in young and falls in elderly
  • Associated injuries are common:
    • Dislocations, radial head fracture, ulnar nerve injury

Clinical Features

  • Pain, swelling, and occasionally over posterior elbow
  • Assess extensor mechanism by assessing elbow extension against resistance
  • Forearm extension strength is reduced (triceps inserts at the olecranon)

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Evaluation

Fracture of the olecranon (arrow).
Fracture of the olecranon on PA and lateral.
  • AP lateral, requires true lateral
  • Radiocapitellar view helps visualize radial head fracture, capitellar shear fracture
  • CT can assist with operative planning

Management

General Fracture Management

  • Acute pain management
  • Open fractures require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
  • Consider risk for compartment syndrome
  • If any limitation to range of motion, orthopedics will often perform elbow arthrocentesis to remove hemarthrosis which is often present
    • The purpose of this is to see whether range of motion is restored after aspiration since if it is not, this may be an indication for surgery
    • This is generally not necessary to perform in the ED but can be done for patient comfort

Specific Management

  • Rule-out ulnar nerve injury
  • Immobilize with long arm posterior mold with elbow in flexion and forearm neutral
  • Refer to ortho within 24hr
  • Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks

See Also

References


  • Orthobullets