Olecrenon fracture

Olecrenon fracture

• 1.
  Olecrenon fracture Dr. AshiqurRahman Resident Orthopedics Dhaka Medical college Hospital
• 2.
   Olecrenon fracturecan be divided into 02 broad categories: 1. Simple transverse fracture: - An avulsion due to fall on the outstretched hand 2. Comminuted fracture: - Due to direct blow or fall on outstretched hand
• 3.
   These canbe further sub-classified into : a) Displaced or b) Undisplaced  And whether there is involvement of ulno-humeral joint, which is largely related to how distal the # is on the olecranon.
• 4.
  Mayo classification ofOlecrenon #
• 6.
   The #always enter the elbow joint & therefore may damage the articular cartilage.  With transverse # the triceps aponeurosis remains intact, in which case the # fragments stay together.  Stress # are a rare occurrence in young athletic individual.
• 7.
  Clinical features: - Swelling& bruising usually evident - A breach of the skin indicates a direct blow to the elbow - A gap may be palpable & pt. unable to extend the elbow against resistance. - Stress # are a rare occurrence in young athletic individual.
• 8.
  X-ray: 1. AP & 2.Lateral view of the elbow - Note should be made of the # pattern - The presence of comminution, degree of displacement - Sign of subluxation of ulno-humeral joint or radio-capitellar joint
• 9.
  Treatment 1. Undisplaced fracture: -Undisplaced # that does not separate when the elbow is X-rayed in flexion can be treated without surgery. - Repeat X-rays are needed to exclude displacement. - Casting is not recommended but a sling for comfort.
• 10.
  2. Displaced fracture: - Operative treatment is recommended for displaced # & those with instability of the ulno-humeral or radio- capitellar joint. - A plate & screws should always be used in all except those with simple transverse # with a stable joint, in whom a suture repair or tension-band repair can be used. - Immediate post-operative mobilization is recommended.
• 12.
  Contra-indication of tensionband wiring 1. Oblique fracture 2. Comminuted fracture 3. Fracture distal to sigmoid notch
• 13.
  Advantages of platefixation: - Plate fixation has the advantage of maintaining fixation in fractures with comminution, distal fractures, and complex fracture-dislocations. - Typically used in neutralization mode, the plating technique allows lag screw fixation of the olecranon and/or coronoid to anatomically reconstruct the proximal ulna. - The plate then provides the overall stability needed to obtain union and initiate an early range of motion program to promote maximal function.
• 14.
  Disadvantages of platefixation - Disadvantage of plate fixation has been symptomatic hardware problems. - Newer pre-contoured plates are lower in profile, provide more screw options for the proximal segment,
• 18.
  Complications: 1. Stiffness : -Common but early mobilization is recommended to avoid elbow stiffness. 2. Nonunion : - Sometimes occurs after inadequate reduction & fixation. 3. Ulnar nerve symptoms: - Although this may occur, they usually settle spontaneously. 4. Osteoarthritis: - Can be late complication.