Fractures of Olecranon

Anatomy

The olecranon process is a large curved eminence comprising the proximal and posterior portions of the ulna. Because it lies beneath the skin, it is very vulnerable  to direct trauma.

Together with  coronoid process, the olecranon forms the articular surface for articulation with the trochlea. This articulation allows movement only in anteroposterior plane.

Triceps tendoninserts into the olecranon posteriorly. Before this it covers  the joint capsule  and forms an aponeurosis by spreading the overlying fascia.

Mechanism of Injury

Direct trauma for example  a fall or blunt trauma on the posterior tip of the elbow.

Indirect trauma is caused by indirect avulsion during a fall on a partially flexed elbow.

Signs and Symptoms

Patient would present with pain and swelling of the elbow. On examination the olecranon would be tender and in displaced cases there could be a palpable gap. Movements at elbow elicit pain. Though rare ulnar nerve injury may accompany. Therefore, nerve examination should be done in detail.

There could be inability to extend the elbow joint against gravity depending upon fracture type and injury to triceps mechanism. In undisplaced fractures, the mechanism would be intact and patient generally would be able to extend the elbow whereas in displaced fractures the mechanism would be disrupted.  The presence or absence of this sign often determines the plan of treatment of these fractures.

A non operative treatment method can be chosen in case the patient is able to extend the elbow against the gravity

Radiographic Imaging

Fracture of the olecranon is best visualized in lateral view xray of elbow. Following things are to be noted

• The extent of the fracture
• The degree of comminution
• The amount of disruption of the articular surface
• Displacement of the radial head

An anteroposterior view is useful  to look for   associated radial head or neck fracture can also be identified on this view

Related posts:

1. Classification and Treatment of Olecranon Fractures
2. Radial Head Fractures – Clinical Presentation and Treatment
3. Radial Head Fractures – Treatment Options
4. Fractures of Radial Head or Head of Radius – The Biomechanics
5. Anterior Dislocation Of Elbow