Olecranon Fractures : Adults

Olecranon is the proximal end of the ulna which articulates with the distal end of humerus to form the elbow joint. It subcutaneous an most prominent part on the posterior aspect of the elbow.

Fracture Mechanism :
      Fractures of olecranon in adults are caused by direct trauma to the elbow like falling on the tip of elbow or indirect like falling on a flexed elbow with a strong contraction of the triceps causing avulsion fracture of the olecranon.

Clinical Features :
      Patient usually presents with a history of trauma in the form of a RTA or a fall with swelling on the elbow. Swelling is more on the back of the elbow due to joint effusion and surrounding soft tissue edema. Pain is severe exaggerated with event slightest of movement. Elbow movements are extremely painfull and patient may not even allow any examination.

Radiographs :
      A good antero-posterior and a lateral radiograph (X-rays)of the elbow are required to diagnose the type of fracture and to plan the appropriate management. See for the amount of displacement, communition and any associatedd fractures like the radial head or any dislocation / subluxation.

Management :
      Immediately on presentation the elbow is immobilised by a above elbow posterior slab, elevation given to reduce edema and adequate analgesics to relieve the pain.
Patient is instructed to do continuous finger movements as tolerated to reduce edema.
There are multiple methods for the treatment of fracture of olecranon:

1. ORIF with a figure of 8 wire loop
2. Medullary fixation
3. Combination of intramedullary pin or screw with tension band
4. Contoured plates and screws
5. Excision of the proxiamal fragments

Complications :

1. Non Union
2. Loss of function extension more than flexion
3. Prominent subcutaneous implant
4. Infection

Post-Operative :
      In the post operative period the limb is supported with a above elbow posterior slab in 90 degrees. Active or active assisted movements are started after 7 to 10 days and elbow supported in a brace in between movements. Support is discontinued after 4 weeks. Repeat radiographs should be done to monitor union.
Usually full function returns within 6 to 12 months. There may be slight restriction of flexion extension of the elbow but supination pronation is usually not affected.