Olecranon Fractures Workup

  • Author: James W Pritchett, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jun 7, 2011
 

Imaging Studies

  • Standard anteroposterior and lateral radiographs of the elbow are sufficient for evaluation of isolated olecranon fractures.
    • Direct supervision of the x-ray process may be necessary to ensure that true anteroposterior and lateral radiographs are obtained.
    • The radiocapitellar view may be helpful for delineation of the radial head and capitellar fractures.
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Staging

Several classification systems have been suggested.

  • The Arbeitsgemeinschaft für Osteosynthesefragen (AO) - Association for the Study of Internal Fixation (ASIF) classification, used by the Orthopaedic Trauma Association, divides the fractures into 3 broad categories as follows[7] :
    • Type A fractures are extra-articular.
    • Type B fractures are intra-articular.
    • Type C fractures are intra-articular fractures of both the radial head and olecranon.
  • Schatzker developed a classification with 6 types as follows (types A, B, and C are intra-articular fractures):
    • Type A is a simple transverse fracture.
    • Type B is a transverse impacted fracture.
    • Type C is an oblique fracture.
    • Type D is a comminuted fracture.
    • Type E is a more distal fracture, which actually is extra-articular.
    • Type F is a fracture dislocation.
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Contributor Information and Disclosures
Author

James W Pritchett, MD  Chief of Orthopedic Surgery, Swedish Orthopedic Institute; Active Staff, Swedish Medical Center

James W Pritchett, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Washington State Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Margaret A Porembski, MD  Physician, Hand Surgery and Specialty Orthopaedic Centers

Margaret A Porembski, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark D Lazarus, MD  Associate Professor of Orthopedic Surgery, Medical College of Pennsylvania-Hahnemann University, Chief of Shoulder and Elbow Service, Department of Orthopedic Surgery, Hahnemann University Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Yaszemski, MD, PhD  Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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  2. Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. Apr 2008;39(2):229-36, vii. [Medline].

  3. Anderson ML, Larson AN, Merten SM, Steinmann SP. Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma. Jul 2007;21(6):386-93. [Medline].

  4. Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg. Oct 13 2009;[Medline].

  5. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am. Oct 2009;91(10):2416-20. [Medline].

  6. Iannuzzi N, Dahners L. Excision and advancement in the treatment of comminuted olecranon fractures. J Orthop Trauma. Mar 2009;23(3):226-8. [Medline].

  7. Mueller ME, Allgower M, Schneider R. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Berlin, Germany: Springer-Verlag; 1991.

  8. Gartsman GM, Sculco TP, Otis JC. Operative treatment of olecranon fractures. Excision or open reduction with internal fixation. J Bone Joint Surg [Am]. Jun 1981;63(5):718-21. [Medline].

  9. Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175-85. [Medline].

  10. Murphy DF, Greene WB, Dameron TB Jr. Displaced olecranon fractures in adults. Clinical evaluation. Clin Orthop. Nov 1987;(224):215-23. [Medline].

  11. Rush LV, Rush HL. A reconstruction operation for a comminuted fracture of the upper third of the ulna. Am J Surg. 1937;38:332-3.

  12. Sultan S, Khan AZ. Management of comminuted fractures of the olecranon by tension band wiring. J Ayub Med Coll Abbottabad. Jul-Sep 2003;15(3):27-9. [Medline].

  13. Erturer RE, Sever C, Sonmez MM, Ozcelik IB, Akman S, Ozturk I. Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. J Shoulder Elbow Surg. Mar 2011;20(3):449-54. [Medline].

  14. Inhofe PD, Howard TC. The treatment of olecranon fractures by excision or fragments and repair of the extensor mechanism: historical review and report of 12 fractures. Orthopedics. Dec 1993;16(12):1313-7. [Medline].

  15. McKeever FM, Buck RM. Fracture of the olecranon process of the ulna: Treatment by excision of the fragment and repair of the triceps tendon. JAMA. 1947;135:1-5.

  16. Moed BR, Ede DE, Brown TD. Fractures of the olecranon: an in vitro study of elbow joint stresses after tension-band wire fixation versus proximal fracture fragment excision. J Trauma. Dec 2002;53(6):1088-93. [Medline].

  17. Wolfgang G, Burke F, Bush D. Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop. Nov 1987;(224):192-204. [Medline].

  18. Simpson NS, Goodman LA, Jupiter JB. Contoured LCDC plating of the proximal ulna. Injury. Jul 1996;27(6):411-7. [Medline].

  19. Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res. Dec 2004;292-300. [Medline].

  20. Papagelopoulos PJ, Morrey BF. Treatment of nonunion of olecranon fractures. J Bone Joint Surg Br. Jul 1994;76(4):627-35. [Medline].

  21. Rettig AC, Waugh TR, Evanski PM. Fracture of the olecranon: a problem of management. J Trauma. Jan 1979;19(1):23-8. [Medline].

  22. Rommens PM, Küchle R, Schneider RU. Olecranon fractures in adults: factors influencing outcome. Injury. Nov 2004;35(11):1149-57. [Medline].

  23. Rommens PM, Schneider RU, Reuter M. Functional results after operative treatment of olecranon fractures. Acta Chir Belg. Apr 2004;104(2):191-7. [Medline].

  24. Schatzker J. Fractures of the olecranon. In: The Rationale of Operative Fracture Care. Berlin, Germany: Springer-Verlag;1991.

 
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Lateral radiograph of the elbow in a 78-year-old man who fell on his outstretched hand is shown. A displaced fracture of the olecranon was noted.
Drawing of a tension band fixation demonstrating dorsal placement of the wire prior to seating the Kirschner wire beneath the triceps.
Drawing depicting the radial bow of the proximal third of the ulna.
Anteroposterior radiograph following reduction and internal fixation of the fracture with a 7.3-mm cannulated screw and 1.6-mm cable.
Lateral radiograph demonstrating the threads of the screw engaging the cortices of the ulna.
 
 
 
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