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An olecranon oh-LEK-rah-nun fracture is a break in the bony "tip" of the elbow. This pointy segment of bone is part of the ulna, one of the three bones that come together to form the elbow joint. The olecranon is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can break easily if you experience a direct blow to the elbow or fall on an outstretched arm. A fracture can be very painful and make elbow motion difficult or impossible.
Treatment for an olecranon fracture depends upon the severity of the injury. Some simple fractures can be treated by wearing a splint until the bone heals. In most olecranon fractures, however, the pieces of bone move out of place when the injury occurs.
For these fractures, surgery is required to restore both the normal anatomy of the elbow and motion in the joint. The elbow joint bends and straightens like a hinge. It is also important for rotation of the forearm; that is, the ability to turn your hand palm up like accepting change from a cashier or palm down like typing or playing the piano. The elbow is held together by its bony architecture, as well as ligaments, tendons, and muscles.
Three major nerves cross the elbow joint. Left The bones of the elbow. The olecranon is the "tip" of the elbow and is part of the ulna. Right The major nerves and ligaments are highlighted. Olecranon fractures are fairly common. Although they usually occur on their own, with no other injuries, they can also be part of a more complex elbow injury. In an olecranon fracture, the bone can crack just slightly or break into many pieces.
The broken pieces of bone may line up straight or may be far out of place displaced fracture. In some cases, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because, once the skin is broken, infection in both the wound and the bone are more likely to occur.
Immediate treatment is required to prevent infection. An olecranon fracture usually causes sudden, intense pain and can prevent you from moving your elbow. Other signs and symptoms of a fracture may include:. Your doctor will talk with you about your medical history and general health and ask about your symptoms. He or she will then examine your elbow to determine the extent of the injury.
During the exam, your doctor will:. Although you may have pain only at the elbow, your doctor may also examine your shoulder, upper arm, forearm, wrist, and hand to ensure that you do not have any other injuries.
X-rays provide images of dense structures, such as bones. Your doctor will order x-rays of your elbow to help diagnosis your fracture. While you are in the emergency room, your doctor will apply a splint like a cast to your elbow, and give you a sling to help keep the elbow in position. Immediate treatment may also include:. Whether or not your fracture requires surgery will be determined.
Not all olecranon fractures will require surgery. If the pieces of bone are not out of place displaced , a fracture can sometimes be treated with a splint to hold the elbow in place during healing. During the healing process, your doctor will take frequent x-rays to make sure the bone has not shifted out of place.
Splints are typically worn for 6 weeks before gentle motion is started. If the fracture shifts in position during this time, you may need surgery to put the bones back together.
Left The doctor will apply a splint that runs from near your shoulder all the way to your hand. Right An elastic bandage is applied to help keep the splint in place.
Surgery for olecranon fractures typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed. Because of the increased risk of infection, open fractures are scheduled for surgery as soon as possible, usually within hours.
Patients are given antibiotics by vein intravenous in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury and the surfaces of the broken bone are thoroughly cleaned out. The bone will typically be repaired during the same surgery. Open reduction and internal fixation. This is the procedure most often used to treat olecranon fractures. During the procedure, the bone fragments are first repositioned reduced into their normal alignment.
The pieces of bone are then held in place with screws, wires, pins, or metal plates attached to the outside of the bone. Bone graft. If some of the bone has been lost through the wound or is crushed, the fracture may require bone graft to fill the gaps.
Bone graft can be taken from a donor allograft or from another bone in your own body autograft —most often the hip.
In some cases, an artificial material can be used. Removal of the fracture fragment. If the broken bone fragment is too small to repair, it is sometimes removed. When this is done, the triceps tendon, which is attached to the fragment, is reattached to the remaining portion of the ulna. There are risks associated with all surgery. If your doctor recommends surgery, he or she thinks that the possible benefits outweigh the risks.
There is a risk of infection with any surgery. Your doctor will take specific measures to help prevent infection. Hardware irritation. A small percentage of patients may experience irritation from the metal implants used to repair the fracture.
Damage to nerves and blood vessels. There is a minor risk of damage to nerves and blood vessels around the elbow. This is an unusual side effect. Sometimes, a fracture does not heal. The fracture may pull apart and the screws, plates, or wires may shift or break. This can occur for a number of reasons, including:. Most fractures hurt moderately for a few days to a couple of weeks.
Many patients find that using ice, elevation holding their arm up above their heart , and simple, non-prescription medications for pain relief are all that are needed to relieve pain. If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days. Be aware that although opioids help relieve pain after surgery, opioid dependency and overdose has become a critical public health issue.
For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Whether your treatment is surgical or nonsurgical, full recovery from an olecranon fracture requires a good effort at rehabilitation. Because nonsurgical treatment can sometimes require long periods of splinting or casting, your elbow may become very stiff.
For this reason, you may need a longer period of physical therapy to regain motion. During rehabilitation, your doctor or a physical therapist will provide you with exercises to help:. You will not be allowed to lift, push, or pull anything with your injured arm for a few weeks. Your doctor will talk with you about specific restrictions.
Depending on the complexity of the fracture and the stability of the repair, your elbow may be splinted or casted for a short period of time after surgery. Physical therapy. Patients will usually begin exercises to improve motion in the elbow and forearm shortly after surgery, sometimes as early as the next day.
It is extremely important to perform the exercises as often as directed. The exercises will only make a difference if they are done regularly. You will not be allowed to lift heavy objects with your injured arm for at least 6 weeks. You will also be restricted from pushing and pulling activities, such as opening doors or pushing up while rising from a chair.
You may be allowed to use your arm for bathing, dressing, and feeding activities. Your doctor will give you specific instructions. He or she will also let you know when it is safe to drive a car. Even with successful treatment, some patients with olecranon fractures may experience long-term complications. In some cases, a patient may not be able to regain full motion in the affected elbow. In most of these cases, the patient cannot fully extend or straighten his or her arm.
Fortunately, the loss of a few degrees of straightening does not usually affect the overall function of the arm. Patients who have significant loss of motion may require intensive physical therapy, special bracing, or further surgery. This is uncommon for olecranon fractures.
See also: Olecranon fracture - Fracture clinics. The main complication of an olecranon fracture is failure to recognise an associated injury such as radial head dislocation. Place arm in above-elbow backslab in 90 degrees elbow flexion and refer to nearest orthopaedics on call service. They are associated with other elbow injuries e. 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. There is usually pain, tenderness and swelling at the fracture site, and decreased range of motion in the elbow. Deformity is not typically a feature unless the olecranon fracture is associated with a radial head dislocation.