Olecranon fracture


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Olecranon fracture

  1. 1. O lecranon Fracture By : Shalini Devani
  2. 2. Introduction: <ul><li>Olecranon fracture is a fracture involving the olecranon process (proximal end) of the ulna bone. </li></ul><ul><li>This process forms a part of the elbow joint that articulates with the trochlea of the humerus bone. </li></ul><ul><li>The olecranon is the proximal bony projection of the ulna at the elbow. </li></ul><ul><li>It may be associated with coronoid fracture as well as Elbow fractures/dislocations. </li></ul>
  3. 3. Patho-anatomy : <ul><li>Proximal fragment may be pulled by the attached Triceps muscle , thus creating a gap at the # site. </li></ul><ul><li>The olecranon is the proximal bony projection of the ulna at the elbow. Olecranon fractures are a diverse group of injuries, ranging from simple nondisplaced fractures to complex fracture dislocations of the elbow joint. </li></ul><ul><ul><li>Depending on the forces acting, Olecranon # can be classified as.. : </li></ul></ul>
  4. 4. Types : <ul><li>Intra or Extra-articular </li></ul><ul><ul><li>Intra: associated with joint effusions & hematoma </li></ul></ul><ul><ul><li>Extra: mostly avulsion type; common in adults. </li></ul></ul><ul><li>Displaced or Undisplaced </li></ul><ul><ul><li>Displaced: >2 mm distance between fracture fragment </li></ul></ul><ul><li>Transverse/Oblique/ Comminuted/ Stable/Unstable </li></ul><ul><ul><li>Stable: fragments are not separate or if separation degree does not increase with flexion to 90 ° </li></ul></ul>
  5. 5. Mechanism Of Injury <ul><li>Being a subcutaneous structure, Olecranon is vulnerable to direct trauma. </li></ul><ul><li>Most common causes are: </li></ul><ul><ul><li>most common mechanism of an olecranon fracture is a fall on the semiflexed supinated forearm </li></ul></ul><ul><ul><li>Next is, direct trauma , as in falls on, or blows to, the point of the elbow </li></ul></ul><ul><li>Occasionally, by hyperextension injuries, such as those resulting in elbow dislocation in adults or supracondylar fractures in children. </li></ul><ul><li>Very rarely, broken by muscular violence , as in throwing </li></ul>
  6. 6. Diagnosis: <ul><li>Symptoms include </li></ul><ul><ul><li>history of trauma is present </li></ul></ul><ul><ul><li>pain and swelling in and around the elbow joint </li></ul></ul><ul><ul><li>tenderness is present at the fracture site </li></ul></ul><ul><ul><li>Crepitus or a gap may be present between the fragments </li></ul></ul><ul><li>TESTS : to check... </li></ul><ul><ul><ul><li>disruption of extensor mechanism , patient should be asked to attempt extension against gravity. </li></ul></ul></ul><ul><ul><ul><li>Unstable fracture is confirmed by inability to extend the elbow. </li></ul></ul></ul><ul><ul><ul><li>Stability of elbow (+MCL) after operative fixation: varus+valgus stree in full extension & moderate flexion. </li></ul></ul></ul>
  7. 7. Radiolodical diagnosis: <ul><li>X-ray confirms the diagnosis. </li></ul><ul><li>They show the fracture and help in it's classification </li></ul>
  8. 8. Treatment GOALS: <ul><li>In young active individuals, </li></ul><ul><ul><li>restoration of the articular surface, </li></ul></ul><ul><ul><li>preservation of motor power, </li></ul></ul><ul><ul><li>restoration of stability, </li></ul></ul><ul><ul><li>prevention of joint stiffness </li></ul></ul><ul><li>In older patients, </li></ul><ul><ul><li>minimization of morbidity </li></ul></ul>
  9. 9. Treatment: <ul><li>Depends on the type: </li></ul><ul><ul><li>Nondisplaced fractures with intact extensor mechanisms may be treated nonoperatively. Three weeks of casting usually is sufficient </li></ul></ul>
  10. 10. <ul><li>Fractures with significan t displacement (>2 mm) or comminution may require surg ical intervention. </li></ul><ul><ul><li>Excision and triceps advancement may be indicated for severely comminuted fractu r es or for patients with osteoporotic bone. </li></ul></ul><ul><ul><li>ORIF - for displaced intra- articu lar fractures. </li></ul></ul><ul><ul><ul><li>Intramedullary screw fixation , with or without a wire or cable, is the most secure. </li></ul></ul></ul><ul><ul><ul><li>Plate fixation </li></ul></ul></ul><ul><ul><ul><ul><li>for extensive comminuted or unstable oblique fractures not amenable to other types of treatment. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>for an associated coronoid fracture </li></ul></ul></ul></ul>
  11. 11. K-wire/ Tension-band wiring
  12. 12. {AP view radiograph following ORIF of the fracture with a 7.3-mm cannulated screw and 1.6-mm cable} <ul><ul><ul><ul><ul><li>{Lateral radiograph demonstrating the threads of the screw engaging the cortices of the ulna.} </li></ul></ul></ul></ul></ul>S C R E W
  13. 13. Plating
  14. 14. Complications.. <ul><li>loss of some movement of the elbow joint </li></ul><ul><li>non union of the fracture (treated by ORIF + BG) ‏ </li></ul><ul><li>arthritis of the elbow joint </li></ul><ul><li>Symptomatic hardware requiring removal is the most frequent complication following internal fixation (k-wire>>nail/plate) ‏ </li></ul><ul><li>Myositis ossificans </li></ul><ul><li>Other rare Complications might include Infection, Reflex Sympathetic Dystrophy,etc. </li></ul>
  15. 15. Prognosis <ul><li>Evaluation criteria: </li></ul><ul><ul><li>degree of pain, </li></ul></ul><ul><ul><li>range of motion, </li></ul></ul><ul><ul><li>radiographic findings. </li></ul></ul><ul><li>Best outcome: patients who have non displaced or minimally displaced fractures treated non operatively </li></ul><ul><li>TBW << Plate-fixation {good results} </li></ul>
  16. 16. Thank-You