1. OLECRANON FRACTURE
Wafer Aldulaimi / Denmark

2. Anatomy

The olecranon and the proc. coronoideus form
the Incisura trochlearis , which articulates with
the trochlea of the distal humerus.

The intrinsic anatomy of this articulation allows
for flexion/extension movement of the elbow
joint and provides for stability of the elbow.

4. Epidemiology

Bimodal distribution.
 high energy injuries in young
 secondary to falls in the elderly

Very rare in children. The same trauma will
cause distal humeral fracture instead.

5.
Mechanismof injury



Direct blow
A fall on an outstretched hand with the elbow in
flexion
Sudden and violent triceps muscle contraction
can produce an avulsion fracture of varying size
of the olecranon tip

7. Evaluation



History
Physical examination
Imaging


Plain radiographs are usually sufficient for isolated
fractures of the olecranon.
CT : may be useful for preoperative planning in
comminuted fractures.

8. Classification

The Mayo classification

9. Colton Classification
Nondisplaced - Displacement does not
increase with elbow flexion
 Avulsion (displaced)
 Oblique and Transverse (displaced)
 Comminuted (displaced)
 Fracture dislocation


10. Schatzker Classification

11. AO Classifiation



Type A: extraarticular
Type B: Intraarticular
Type C: Intra-articular fractures of both the radial
head and olecranon

12. Treatment

Goals:




Articular restoration
Preservation of the extensor mechanism
Elbow stability
Avoidance of stiffness and maintain the range of
motion

13. 
Nonsurgical:



Nondisplaced fractures (< 2mm dislocation) can be
effectively treated by immobilization of the limb in
a long-arm splint or cast with the elbow flexed at
45-90° for 4 weeks.
Displaced fracture is low demand, elderly
individuals
Contraindications include active infection and
severe medical comorbidities.

14. Surgical procedures

Tension band wiring technique over two
Kirschner wires

15. 
Contoured plate application to the posterior
aspect of the proximal ulna

16. 
Intramedullary fixation

17. 
Fragment excision and triceps reattachment

18. Complication








Symptomatic hardware most frequent reported
complication
Stiffness occurs in ~50% of patients ,usually doesn't
alter functional capabilities
Heterotopic ossification more common with
associated head injury
Posttraumatic arthritis
Nonunion rare (5%)
Ulnar nerve symptoms
Anterior interosseous nerve injury
Loss of extension strength

19. Tension band technique

Fracture reduction

20. 
Drilling

21. 
Wire preparation and insertion

22. 
First K-wire insertion

23. 
Second K-wire

24. 
Figure-of-eight configuration

25. 
Tightening the wire

27. 
Prevent later soft-tissue irritation

28. 
Sinking the K-wires

29. 
The end result

30. References:

AO Principles of Fracture Management: Thomas P. Ruedi , William M. Murphy

Rockwood and Green's Fractures in Adults

AAOS