Olecranon

Scenario

A 56YO male presents after falling onto his elbow. The following X-Rays are taken.

Olecranon fracture

Image sourced from https://en.wikipedia.org/wiki/Olecranon_fracture used under CC BY-SA 4.0

This is a lateral plane film radiograph of an unknown skeletally mature individuals elbow. There is an intra-articular comminuted fracture of the patient’s olecranon. There is evidence of proximal displacement of the proximal fragment. Classification would be a mayo 2b.

I would classify olecranon fractures according to the Mayo classification system.

Mayo

1 un-displaced

A noncomminuted

B comminuted

2 displaced stable

A noncomminuted

B comminuted

3 Unstable (disruption at the ulnar humeral joint)

A noncomminuted

B comminuted

  • I would use tension band wife fixation for simple pattern fractures at the level of the trochlear notch and proximally.
  • For more complicated fracture patterns, fracture dislocation, injuries where the joint is subluxed or comminuted fractures I would use plate fixation.

A dorsally applied tension band converts the normally distractive (tensile) force of the triceps into a compressive force. The principle relies on bony contact at the volar cortex. Therefore, it is not suitable for fractures with significant comminution.

Duckworth et al 2017 reports good outcomes in low functional demand patients with olecranon fractures who are treated with pain relief, a short period of splintage (cast immobilisation 45-90degrees).