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Olecranon fracture
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  • 1. OLECRANON FRACTURE Wafer Aldulaimi / Denmark
  • 2. Anatomy  The olecranon and the proc. coronoideus form the Incisura trochlearis , which articulates with the trochlea of the distal humerus.  The intrinsic anatomy of this articulation allows for flexion/extension movement of the elbow joint and provides for stability of the elbow.
  • 3. Epidemiology  Bimodal distribution.  high energy injuries in young  secondary to falls in the elderly  Very rare in children. The same trauma will cause distal humeral fracture instead.
  • 4.   Mechanismof injury     Direct blow A fall on an outstretched hand with the elbow in flexion Sudden and violent triceps muscle contraction can produce an avulsion fracture of varying size of the olecranon tip
  • 5. Evaluation     History Physical examination Imaging   Plain radiographs are usually sufficient for isolated fractures of the olecranon. CT : may be useful for preoperative planning in comminuted fractures.
  • 6. Classification   The Mayo classification
  • 7. Colton Classification Nondisplaced - Displacement does not increase with elbow flexion  Avulsion (displaced)  Oblique and Transverse (displaced)  Comminuted (displaced)  Fracture dislocation 
  • 8. Schatzker Classification
  • 9. AO Classifiation    Type A: extraarticular Type B: Intraarticular Type C: Intra-articular fractures of both the radial head and olecranon
  • 10. Treatment  Goals:     Articular restoration Preservation of the extensor mechanism Elbow stability Avoidance of stiffness and maintain the range of motion
  • 11.  Nonsurgical:    Nondisplaced fractures (< 2mm dislocation) can be effectively treated by immobilization of the limb in a long-arm splint or cast with the elbow flexed at 45-90° for 4 weeks. Displaced fracture is low demand, elderly individuals Contraindications include active infection and severe medical comorbidities.
  • 12. Surgical procedures  Tension band wiring technique over two Kirschner wires
  • 13.  Contoured plate application to the posterior aspect of the proximal ulna
  • 14.  Intramedullary fixation
  • 15.  Fragment excision and triceps reattachment
  • 16. Complication         Symptomatic hardware most frequent reported complication Stiffness occurs in ~50% of patients ,usually doesn't alter functional capabilities Heterotopic ossification more common with associated head injury Posttraumatic arthritis Nonunion rare (5%) Ulnar nerve symptoms Anterior interosseous nerve injury Loss of extension strength
  • 17. Tension band technique  Fracture reduction
  • 18.  Drilling
  • 19.  Wire preparation and insertion
  • 20.  First K-wire insertion
  • 21.  Second K-wire
  • 22.  Figure-of-eight configuration
  • 23.  Tightening the wire
  • 24.  Prevent later soft-tissue irritation
  • 25.  Sinking the K-wires
  • 26.  The end result
  • 27. References:  AO Principles of Fracture Management: Thomas P. Ruedi , William M. Murphy  Rockwood and Green's Fractures in Adults  AAOS