Olecranon Fracture

Welcome to Vrije Universiteit Brussel's Evidence-based Practice project. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Andries Derycker

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Introduction

Olecranon fractures are frequently occurring elbowdisorders. These fractures are regarded as one of the simplest articular lesions and its operative and physiotherapeutic treatment straightforward.
Intraarticular fractures account for the majority of olecranon fractures and are generally associated with joint effusions and hematomas. Extraarticular fractures include avulsion fractures and are most commonly seen in the elderly.^{1, 8}

Causes

The first main cause of olecranon fractures is when people fall on the for arm. The olecranon is, in such direct trauma, forced into the distal humerus. The great pressure on the olecranon is caused by a hyperextension of the elbow and an outstretched hand. ²
The second cause is the result from an indirect mechanism through triceps contraction. The triceps tendon is associated intimately with the periosteum overlying the olecranon. The contraction of this muscle avulses the olecranon and tears the distal triceps expansion. That’s the reason why sportsmen, p.e. wrestlers and gymnasts, that generate a lot of isometric arm power are a risk group. Patients with a broken olecranon are unable to extend their arm.^{1, 7}

Treatment

Management of olecranon fractures depends on displacement, comminution , and elbow stability. According to ‘the Mayo classification system of olecranon fractures’, based on the displacement of the olecranon, there are 3 types of treatment.
The nondisplaced fractures (type I) should be cured with immobilization and symptomatic treatment. Immobilization is discontinued within 2 weeks and active motion without resistance is initiated. Type II- and III-fractures include a displacement with intact collateral ligaments (II) and respectively with a disruption in the relationship between the forarm and the humerus (III).
Types II and III require surgical fixation. There are several options for fixation:

• Tension band wiring for fixation of noncomminuted transverse fractures involving less than half the articular olecranon surface. A study has shown that after four months of following post-operative care, the evolution in mean range of motion was splendid: 15° flexion, 135° extension, 70° pronation and 79° supination. Complications of tension band wiring include loss of fixation, nonunion, skin breakdown, infection, olecranon bursitis, radial head subluxation, and prominent hardware.
• Comminuted fractures need plate fixation because it’s a more stable fixation. Studies demonstrate that after a year excellent results can be reached: perfect union rate and no hardware complication by using this technique.
• Intramedullary screw fixation is similar to tension band wiring, and include simple, noncomminuted transverse fracture patterns. Studies demonstrated superior results to tension band wiring for pain, function, and range of motion. Biomechanical studies have been less optimistic because there can be loss of fixation. This loss could be the result of wrong proportions of the screw.
• When the articular surface is too comminuted or too osteoporotic for fixation (p.e. with elderly or low- demand patients), then it’ s better to use the ‘olecranon exision’- and/or the ‘triceps advancement’-technique . Otherwise bonereconstruction would be impossible. The triceps tendon is reattached to the proximal edge of the articular surface. Outcomes of this technique is variable: p.e. a biomechanical study showed that there’s an increase of triceps strength

Generally, the migration of osteosynthesis can be the cause of ulnar nerve palsy, infection,… Functional difficulties in daily life were more than halved after metal removal.
Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment.^{1, 2, 3, 4, 5, 6}

Epidemiology /Etiology

add text here

Characteristics/Clinical Presentation

add text here

Differential Diagnosis

add text here

Diagnostic Procedures

add text here related to medical diagnostic procedures

Outcome Measures

add links to outcome measures here (also see Outcome Measures Database)

Examination

add text here related to physical examination and assessment

Medical Management

add text here

Physical Therapy Management

add text here

Key Research

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources

add appropriate resources here

Clinical Bottom Line

add text here

Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

References

see adding references tutorial.