What are the potential complications associated with this injury? Joint stiffness may occur in olecranon fractures, with associated injuries, if there is a delay in recognition or if synostosis (Figure 4)/heterotopic ossification develops.įigure 4: Synostosis of elbow showing limited supination and pronation of the left forearm. The outcome is not always good despite good management. However, elbow injuries can be unpredictable and therefore close follow-up (including serial x-rays) is important. What advice should I give to parents?Ī good outcome is expected for isolated stable/undisplaced fractures. Undisplaced/stable fractures should be seen in fracture clinic in one week, with x-ray at that visit.įor displaced fractures and those with associated injuries, follow-up care will be arranged by the orthopaedic service. These fractures typically require operative management. Isolated undisplaced/stable fractures should be immobilised in an above-elbow backslab in 90 degrees elbow flexion.įor displaced and combined fractures, the arm should be placed in an above-elbow backslab in 90 degrees elbow flexion and referred to the nearest orthopaedic on call service. What is the usual ED management for this fracture? Neurovascular injury with fracture (rare) 9. Associated injuries around the elbow, e.g.Indications for prompt consultation include: All displaced fractures are unstable and will require reduction and fixation. When is reduction (non-operative and operative) required?Īpproximately 80% of olecranon fractures are undisplaced or minimally displaced and require immobilisation only. Olecranon fracture with associated injuryįigure 2: Olecranon fracture associated with radial head subluxation dislocation (note lateral swelling).įigure 3: Olecranon fracture with radial neck fracture.ħ. If uncertainty exists then compare AP and lateral views of the contralateral elbow. TIP: A line drawn down the shaft of the radius should point to the center of the capitellum in both AP and lateral x-ray views to exclude radial head dislocation.īeware mistaking the olecranon growth plate for a fracture and vice versa. radial head dislocations (Monteggia variant), radial neck fracture or lateral condyle fracture, etc. What do they look like on x-ray? Isolated olecranon fractureįigure 1: Isolated olecranon fracture (typically transverse and involve the elbow joint).Īlways closely examine for other injuries around the elbow, e.g. X-rays of the entire forearm are indicated if a radial head dislocation (Monteggia variant fracture) is suspected on the initial elbow films. 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. What radiological investigations should be ordered?Īn anteroposterior (AP) and lateral view of the elbow should be obtained. There is usually pain, tenderness and swelling at the fracture site, and decreased range of motion in the elbow.ĭeformity is not typically a feature unless the olecranon fracture is associated with a radial head dislocation.Īlways look for an associated injury, especially dislocation of the radial head.ĥ. These 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. radial head dislocation, lateral condyle fracture, radial neck fracture or supracondylar fracture). They are associated with other elbow injuries (e.g. These fractures account for 5% of all fractures of the elbow region. How common are they and how do they occur? radial head dislocation, lateral condyle fracture, radial neck fracture, supracondylar fracture)ģ.
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