Transcript
OLECRANON FRACTURE
Wafer Aldulaimi / Denmark
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.
Epidemiology
Bimodal distribution.high energy injuries in youngsecondary to falls in the elderly
Very rare in children. The same trauma will
cause distal humeral fracture instead.
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
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.
Classification
The Mayo classification
Colton Classification
Nondisplaced - Displacement does not increase with elbow flexion
Avulsion (displaced) Oblique and Transverse (displaced) Comminuted (displaced) Fracture dislocation
Schatzker Classification
AO Classifiation
Type A: extraarticular Type B: Intraarticular Type C: Intra-articular fractures of both the radial
head and olecranon
Treatment
Goals: Articular restoration Preservation of the extensor mechanism Elbow stability Avoidance of stiffness and maintain the range of
motion
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.
Surgical procedures
Tension band wiring technique over two Kirschner wires
Contoured plate application to the posterior aspect of the proximal ulna
Intramedullary fixation
Fragment excision and triceps reattachment
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
Tension band technique
Fracture reduction
Drilling
Wire preparation and insertion
First K-wire insertion
Second K-wire
Figure-of-eight configuration
Tightening the wire
Prevent later soft-tissue irritation
Sinking the K-wires
The end result
References: AO Principles of Fracture Management: Thomas P. Ruedi , William M. Murphy Rockwood and Green's Fractures in Adults AAOS
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