Paediatric Olecranon Fracture
Olecranon fractures account for 5% of all fractures of the elbow region.
They are associated with other elbow injuries (e.g. radial head dislocation [Monteggia variant], lateral condyle fracture, radial neck fracture, or supracondylar fracture).
Olecranon fractures can be classified according to:
Anatomical location: metaphyseal (most common), physeal (growth plate), epiphyseal
Fracture pattern: transverse, oblique, longitudinal
Displacement (whether undisplaced/stable or displaced/unstable)
Olecranon fractures usually occur as a result of direct trauma to the flexed elbow or indirect forces such as a fall on the outstretched hand, with a varus or valgus stress to the elbow joint.
There is usually pain, tenderness, and swelling at the fracture site, and decreased range of motion in the elbow.
The deformity is not typically a feature unless the olecranon fracture is associated with a radial head dislocation.
All fractures should be assessed using the Advanced Trauma Life Support (ATLS) principles to ensure associated and potentially significant injuries are identified.
An anteroposterior (AP) and lateral view of the elbow should be obtained. It important that the lateral view is a true lateral and that the AP clearly shows the relationship of the proximal radius and ulna to the humerus.
Beware mistaking the olecranon growth plate for a fracture and vice versa. If uncertainty exists then compare AP and lateral views of the contralateral elbow.
Approximately 80% of olecranon fractures are undisplaced or minimally displaced and require immobilization only. Isolated undisplaced /stable fractures should be immobilized in an above-elbow back slab in 90 degrees elbow flexion.
All displaced fractures are unstable and will require reduction and fixation.
Operative indications are as follows-
Associated injuries around the elbow, e.g. radial head dislocation
Neurovascular injury with fracture (rare)
Emphasis should be placed on the elevation of the limb (elbow above the heart) for the first 48 hours and active finger mobilization.
Back slab and sling should be worn under clothing and not through the sleeve.
A good outcome is expected for isolated stable/undisplaced fractures.
However, elbow injuries can be unpredictable and therefore close follow-up (including serial x-rays) is important. The outcome is not always good despite good management.
Joint stiffness may occur in olecranon fractures, with associated injuries, if there is a delay in recognition or if synostosis /heterotopic ossification develops.
Poorer outcome than anticipated by doctor/parents.
Stiffness (failure to regain full elbow ROM)
Proximal radiohumeral dysfunction in combined injuries
Ulnar nerve injury