Olecranon Fractures

Fractures of the olecranon are common because of its subcutaneous location. The mechanism of injury is usually direct trauma to the tip of the elbow. Olecranon fractures may be avulsions, oblique or transverse intraarticular, or comminuted. Clinical findings include swelling and tenderness over the olecranon, limitation of movement, a palpable fracture line, and inability to fully extend the elbow. Because of its proximity, examination is especially directed at evaluation of ulnar nerve function. Ulnar nerve injuries are usually transient neuropathies. Standard anteroposterior and lateral radiographs will identify the fracture, the extent of comminution, and the articular surface involved. As many as 32 percent of olecranon fractures may be associated with other fractures, the commonest being fractures of the radial head or neck.

Undisplaced fractures (< 2 mm displacement) in both flexion and extension are treated with splint immobilization with the elbow placed in 45° of flexion. Follow-up is within 1 week. Displaced fractures (> 2 mm displacement) are treated by open reduction and excision of the proximal olecranon fragments or internal fixation with screws, plates, or tension-band wiring. Complications include loss of rOm, nonunion, ulnar nerve compression, and posttraumatic arthritis.

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