Olecranon fracture

General

The olecranon is a part of the ulna, the prominent piece of bone at the back of your

elbow.

 It is usually broken following a fall on the tip of the elbow.

 The olecranon allows for attachment of the triceps muscle which allows you to straighten

(extend) the elbow .

 Diagnosis

The diagnosis is usually made on the history of the patient falling directly on the point of the elbow.

 The pain is felt at the back of the elbow.

 If the fracture is displaced then you may not be able to actively straighten the arm.

 The elbow may be swollen and the bruising normally only comes out days later.

 X rays are needed to be sure if it is broken or not.

Treatment

Mouseover image if you

can't see the fracture.

Treatment depends on whether the fracture is displaced or undisplaced.

 Most olecranon fractures are displaced and require operative treatment (surgery).

 If the fracture is displaced and the fracture fragments have moved far apart, then the triceps muscle will no longer work and the arm will remain

weak.

 If the joint surface is not smooth, the joint may wear out, developing arthritis. Displaced fractures are therefore usually treated with an operation, to

put the bones back in the correct place and hold them in the correct place until they heal.

 If the fracture is undisplaced and the pieces have not moved far apart, then treatment is non operative.

 In frail elderly patients non operative treatment may be considered if the patient is not fit for surgery.

Operative treatment

The most common way to fix olecranon fractures is with figure of 8 tension band wiring.

Sometimes a plate and screws will be used. Irrespective of the method of fixation the metal is often prominent under the skin and most patients ask

to have the metal removed once the fracture has healed.

 New devices are being developed to be able to fix these fractures without prominent metalwork.

 The most common complication is prominent metalwork and wound healing over the point of the elbow.

 Generally healing is 6 weeks nothing heavier than a cup of tea and 3 months before doing any heavy work.

Non operative treatment

 Non operative treatment is usually reserved for undisplaced fractures (<2mm) or patients not fit for surgery.

 The elbow is immobilised for a short period of time, followed by gentle range of motion exercises.

 Lifting nothing heavier than cup of tea 6 weeks followed by gradual strengthening.

 Some fractures do not heal with bone but with fibrous (scar) tissue.

 This scar tissue may be strong enough for patients to do light work.

 If the patient needs to do heavy work then secondary fixation can be undertaken.

Outcome

 The outcome is generally good most patients get back a functional range of motion.

 Some loss of  extension is common but not normally a problem.

 The joint is involved and some minor arthritis in the joint again is common but seldom requires further treatment.