37. Olecranon Fracture

Case 37


History and Physical Examination


A 45-year-old right-hand-dominant factory worker tripped on an electrical cord several hours prior to admission and fell directly onto his flexed elbow. He reports the inability to actively extend his elbow. He also complains of significant posterior elbow pain and crepitation.


Moderate swelling and pain to palpation are present in the posterior elbow. He does have minimal active triceps strength, but has passive range of motion of the elbow of 30 to 120 degrees.


image


Figure 37–1. Anteroposterior (AP) (A) and lateral (B) radio-graphs of the elbow.


Differential Diagnosis


1. Triceps avulsion


2. Olecranon fracture


3. Elbow dislocation


4. Elbow contusion




PITFALL


• Minimizing the prominence of hardware is imperative to reducing the chances for the necessity of hardware removal. Prominent hardware can even lead to skin breakdown and infection.


Radiologic Findings


Anteroposterior (AP) and lateral radiographs of the elbow are obtained (Fig. 37–1).


Diagnosis


Displaced Olecranon Fracture. The inability of the patient to actively extend his elbow in conjunction with the swelling and pain posteriorly suggests a displaced olecranon fracture. Radiographs confirm the fracture. Diagnosis is relatively straightforward and not easily confused with other pathologies once radiographs are obtained. Careful evaluation of the radiographs, however, is important in deciding on the best form of surgical repair. Olecranon fractures are not uncommonly associated with other elbow fractures including radial head fractures. Likewise, ligamentous disruptions of the medial ulnar collateral ligament and/or the lateral collateral ligament complex can occur as well. Significant ligamentous disruptions with certain olecranon fracture patterns can allow for subluxation of the ulnohumeral articulation, greatly complicating treatment. Failure to identify ulnohumeral subluxation can lead to significantly reduced functional improvement.


Surgical Management

Only gold members can continue reading. Log In or Register to continue

Jan 28, 2017 | Posted by in ORTHOPEDIC | Comments Off on 37. Olecranon Fracture
Premium Wordpress Themes by UFO Themes