Olecranon fracture

The triceps inserts on the olecranon, so a transverse fracture is pulled apart and the patient loses active elbow extension. It is an intra-articular fracture of the trochlear notch.

Mechanism

Fall onto the point of the elbow (direct) or onto the outstretched hand with a contracting triceps.

Clinical findings

• Palpable gap, inability to extend the elbow against gravity. Check the ulnar nerve.

Imaging

• AP and true lateral of the elbow (the lateral shows displacement and comminution).
• Look for an associated radial head fracture or dislocation.

• A true lateral view shows displacement and comminution; look for an associated radial head fracture or dislocation (fracture-dislocation).

Classification

Mayo I

Undisplaced.

Mayo II

Displaced, stable elbow (A non-comminuted, B comminuted).

Mayo III

Displaced, unstable elbow.

Types shown in 3D

Mayo I

Undisplaced (< 2 mm), extensor mechanism intact: early protected motion.

Mayo IIA

Displaced, simple, stable elbow: tension-band wiring.

Mayo IIB

Displaced, comminuted, stable elbow: plate fixation (tension band would collapse the notch).

Mayo III

Displaced and unstable: fracture-dislocation (the forearm slips forward with the distal ulna). Plate and restore the trochlear notch; check the coronoid and radial head.

Treatment

Non-operative

Undisplaced with intact extension, or very low-demand elderly patients (often good function despite displacement): sling, early motion.

Operative

Tension-band wiring for simple transverse fractures; a contoured posterior locking plate for oblique, comminuted fractures and fracture-dislocations.

Aftercare

Early active motion after stable fixation.

Complications

• Symptomatic hardware (frequent)
• Loss of extension
• Ulnar neuritis
• Post-traumatic arthritis