Olecranon Fractures Clinical Presentation

Updated: Dec 07, 2023
  • Author: Steven I Rabin, MD, FAAOS; Chief Editor: Thomas M DeBerardino, MD, FAAOS, FAOA  more...
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Patients who have sustained olecranon fractures typically present with deformity, swelling, and pain; often, they are unable to extend the elbow. In some cases, however, symptoms of stress fractures may be vague, lacking deformity and swelling, and the ability to extend the elbow may be preserved (though extension is usually painful). The clinician should have a high index of suspicion for stress fracture in throwing athletes who present with olecranon soreness or pain. [6]

The clinician should have a high index of suspicion for open fractures because the ulnar border is subcutaneous and even superficial wounds can expose the underlying bone.


Physical Examination

Although most olecranon fractures are isolated, additional injuries to the same extremity are possible. Careful examination of the extremity (including assessment of the shoulder, clavicle, humerus, wrist, hand, and forearm) is essential.

Typically, the elbow incurs both soft-tissue injury and joint effusion. Examine the skin, the radial and ulnar pulses, and the function of the ulnar, median, and posterior interosseous nerves. The ulnar nerve is at especially high risk because of its relatively superficial position on the medial aspect of the elbow. Although this is a rare occurrence, the forearm should always be evaluated for compartment syndrome.

Careful assessment of isolated injuries is vital. Fracture of the coronoid process or the radial head and Monteggia fracture-dislocations have a significant impact on elbow stability. When a supracondylar humerus fracture occurs in conjunction with an olecranon fracture, exposure of the humerus can be obtained by using the olecranon fracture site. Similarly, when an associated coronoid or radial head fracture exists, reduction and fixation can be achieved via a direct posterior approach through the displaced olecranon fragment.

A high index of suspicion for associated injuries is warranted in the evaluation of patients with multiple injuries. Some 20% of patients with high-energy trauma have associated injuries (eg, long-bone fracture, skull fracture, splenic injury, pulmonary contusion, axillary artery rupture).

A transverse or slightly oblique break near the base of the olecranon is the usual fracture. In oblique fractures, the fracture line tends to slope down and back and emerges on the posterior border of the olecranon. In other instances, a small piece of bone is pulled off of the proximal end of the olecranon.