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Did you know? A fractured olecranon at the elbow may cause numbness in the fingers!
An olecranon fracture of the elbow is a break in the bone of the elbow. This injury is fairly common and usually occurs from a fall or direct blow. The fracture occurs at the proximal end of the ulna, which joins the humerus to form a mirror joint at the elbow, a unique position that also makes it vulnerable to direct impact.
The victim usually experiences severe elbow pain following a direct blow or fall, along with swelling at the affected area and an inability to straighten the elbow. Because the olecranon bone is close to the ulnar nerve, injury and swelling may cause numbness and tingling in the fourth and fifth fingers of the hand.
Symptoms and signs
Symptoms of an olecranon fracture include severe elbow pain, swelling, and an inability to extend the elbow, which may cause discomfort with every movement. In addition, a palpable defect is often found at the fracture site during examination.
Injury Mechanics
Olecranon fractures are relatively common and occur as a result of a direct blow to the elbow (e.g. in a traffic accident) or from a fall, resulting in contraction of the triceps muscle. If your elbows are placed against the window while driving, you may also suffer side impact injuries. Multiple fractures can occur when the elbow is hit by a fall or a heavy object. In addition, indirect trauma can also occur through the act of reaching out to try to cushion the impact of the ground.
Diagnosis
The doctor will perform a careful skin examination to ensure that no open fractures are present and do a complete upper extremity neurologic examination. Typically, front-to-back and side-to-side x-rays are taken to determine if an olecranon fracture is present. In particular, lateral X-rays are critical for assessing fracture pattern, degree of displacement, degree of fragmentation, and degree of joint involvement.
Classification of fractures
Several different fracture classifications are used to describe the different forms of olecranon fractures; however, no single classification is universally accepted.
Mayo classification
Fractures are classified into three types based on stability, deviation, and fragmentation, each of which has two subtypes:
- Type I: Non-offset fracture
- Type II: offset stable fracture
- Type III: Offset unstable fracture
AO Classification
Includes all fractures of the proximal ulna and radius and is divided into three patterns:
- Type A: Extra-articular fracture of the ulna or radius
- Type B: intra-articular fracture of the ulna or radius
- Type C: Complex fracture involving the proximal ulna and radius
Schatzker Classification
This classification focuses on the shape and location of the fracture, including simple transverse fractures and fracture-dislocations.
TreatmentTreatment of non-offset fractures
For cases with less fracture displacement, a posterior brace is usually used, with the elbow fixed in a 45°-90° flexion position for 3 weeks, followed by limited flexion motion.
Treatment of Displaced FracturesMost olecranon fractures require surgery.
Tension band fixation
This is the most common form of internal fixation and is indicated for nonfragmented olecranon fractures, usually using Kirschner wires to convert tension into compression.
Intramedullary fixation and plate fixation
Simple transverse or oblique fractures can be treated with a single intramedullary screw, and plate fixation is widely used for all proximal ulna fracture types.
Resection and triceps anterior transfer
It is suitable for situations where initial fracture repair is unsuccessful, such as multiple fractures, osteoporosis in elderly patients, or nonunion of small fractures.
EpidemiologyOlecranon fractures are relatively uncommon in children, accounting for only 5% to 7% of all elbow fractures. This is because in early life, the olecranon bone is thicker, shorter, and stronger relative to the humerus. However, in adults, olecranon fractures are a common injury because of the exposed position of the elbow.
After learning about this information about olecranon fractures, can we better understand the impact this fracture may have on our daily lives?
