Olecranon Fracture

Definition

 

Intra-articular proximal ulna fracture

 

Anatomy

 

Articulates with trochlea

- may have a central bare area

 

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

 

Management

 

Non operative Management

 

Undisplaced fracture

- need to ensure triceps mechanism is intact

- Long arm POP 3/52 in 90o flexion

 

Operative Management

 

Indications

 

1.  Disruption of extensor mechanism

- any displaced fracture

2.  Articular incongruity

 

Options

 

TBW

Plate

Excision fragment / triceps advancement

 

TBW Technique

 

Elbow Olecranon FractureOlecranon Fracture AP TBWOlecranon TBW Lateral

 

Goal

- convert the tensile distraction force of triceps into a compressive force at the articular surface

 

Options

- bi-cortical K wires

- intra-medullary k wires

- intramedullary screw

 

Contraindication

- fracture distal to centre of rotation / midpoint of trochlea notch

- highly comminuted fractures

- oblique fractures

- best to use plate in these situations

 

Technique

- lateral decubitus over bolster

- curvilinear incision to avoid prominence of olecranon

- clean and washout haematoma

- reduction (extend elbow to defunction triceps / place bone forcep)

- 2 x IM k wires (no need to bite anterior cortex / risk nerve injury)

- drill hole in ulna, pass 20 gauge wire

- form figure of 8 wire about wires, can pass under triceps

- twist via 2 knots

- bury end of K wires under triceps

 

Screw / TBW

 

Beware bow of proximal ulna

- may cause medial shift

- avoid long screw

 

Plate

 

Olecranon Fracture Lateral

 

Indication

- fracture distal to centre of rotation

 

Main problem is hardware prominence

- precontoured low profile

- proximal hooks to grip triceps

- beware over compression articular surface in comminuted fractures

 

Olecranon Plate

 

Excision fragment / triceps advancement

 

Indications

- elderly

- osteoporotic

- < 50% articular surface

- non reconstructable