Olecranon fracture: Difference between revisions
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{{Adult top}} [[olecranon fracture (peds)]] | |||
==Background== | ==Background== | ||
*Occurs via direct trauma or by fall | *Occurs via direct trauma or by fall with forced hyperextension of elbow | ||
*Common in high energy mechanism in young and falls in elderly | *Common in high energy mechanism in young and falls in elderly | ||
*Associated injuries are common: | *Associated injuries are common: | ||
**Dislocations, radial head | **Dislocations, radial head fracture, ulnar nerve injury | ||
==Clinical Features== | ==Clinical Features== | ||
*Pain, swelling, and occasionally over posterior elbow | *Pain, swelling, and occasionally over posterior elbow | ||
*Assess extensor mechanism by assessing elbow extension against resistance | |||
*Forearm extension strength is reduced (triceps inserts at the olecranon) | *Forearm extension strength is reduced (triceps inserts at the olecranon) | ||
| Line 12: | Line 14: | ||
{{Elbow DDX}} | {{Elbow DDX}} | ||
== | ==Evaluation== | ||
[[File:OlecranonFracMark.png|thumb|Fracture of the olecranon (arrow).]] | |||
[[File:PMC4231343 1471-2474-14-308-2.png|thumb|Fracture of the olecranon on PA and lateral.]] | |||
*AP lateral, requires true lateral | *AP lateral, requires true lateral | ||
*Radiocapitellar view helps visualize radial head | *Radiocapitellar view helps visualize radial head fracture, capitellar shear fracture | ||
*CT can assist with operative planning | *CT can assist with operative planning | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Rule-out ulnar nerve injury | *Rule-out ulnar nerve injury | ||
*Immobilize | *Immobilize with long arm posterior mold with elbow in flexion and forearm neutral | ||
*Refer to ortho | *Refer to ortho within 24hr | ||
*Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks | *Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks | ||
==See Also== | ==See Also== | ||
| Line 29: | Line 36: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
*Orthobullets | *Orthobullets | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 23:39, 28 November 2019
This page is for adult patients. For pediatric patients, see: olecranon fracture (peds)
Background
- Occurs via direct trauma or by fall with forced hyperextension of elbow
- Common in high energy mechanism in young and falls in elderly
- Associated injuries are common:
- Dislocations, radial head fracture, ulnar nerve injury
Clinical Features
- Pain, swelling, and occasionally over posterior elbow
- Assess extensor mechanism by assessing elbow extension against resistance
- Forearm extension strength is reduced (triceps inserts at the olecranon)
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- AP lateral, requires true lateral
- Radiocapitellar view helps visualize radial head fracture, capitellar shear fracture
- CT can assist with operative planning
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific Management
- Rule-out ulnar nerve injury
- Immobilize with long arm posterior mold with elbow in flexion and forearm neutral
- Refer to ortho within 24hr
- Elderly with limited mobility, consider non-op, splint at 45-90 degrees for 3-4 weeks
See Also
References
- Orthobullets