Other injuries associated with a fall on an outstretched hand include wrist ligament and bony injuries and radial head fractures. Ensure to check the neurovascular status of the affected limb. The disruption to the triceps mechanism means often there is an inability to extend the elbow against gravity*. On examination, there is typically tenderness when palpating over the posterior aspect of the elbow, with a potential palpable defect present. Olecranon fractures typically present with a history of falling on an outstretched hand followed by elbow pain, swelling, and lack of mobility. Figure 1 - Anterior and posterior views of the articulations of the elbow joint Clinical Features There is a very high rate of removal of metalwork, as due to the very superficial nature of the injury, it often impacts the patient significantly.Non-operative management is usually indicated for displacement 2mm, requiring (depending on fracture configuration) techniques such as tension band wiring (if fracture proximal to the coranoid process) or olecranon plating (if at level of, or distal to, the coranoid process) may be used.Management will often vary between centre, surgical preference, and patient factors, however as an overview: Any complex injuries such as fracture dislocations or neurovascular compromise should warrant urgent senior discussion. Treatment is usually guided by the degree of displacement on imaging. Less commonly, in younger patients, these are high energy injuries resulting from direct trauma and may be associated with other forearm injuries or fractures.Įnsure the patient is resuscitated appropriately and stabilised, prior to definitive management of the fracture. The triceps muscle will also act to further distract the fracture this is important to appreciate as it influences the management of these injuries. Fractures of the olecranon typically result from indirect trauma when a patient falls on an outstretched arm, resulting in the sudden pull of the triceps (and brachialis) muscle. The olecranon is the site of insertion for the triceps muscles. It articulates with the trochlea of the distal humerus and therefore all olecranon fractures are intra-articular fractures. The olecranon is the region of the proximal ulna from its tip to the coronoid process. In this article, we will look at the pathophysiology, clinical features, investigations and management of olecranon process fractures. They occur with a bimodal age distribution occurring in the young following high energy injuries or (more commonly) in older patients following low energy indirect injuries. Olecranon process fractures are relatively common fractures of the upper limb.
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