Olecranon fracture

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Olecranon fracture

  1. 1. OLECRANON FRACTURE Wafer Aldulaimi / Denmark
  2. 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. 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. 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. 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. 6. Classification   The Mayo classification
  7. 7. Colton Classification Nondisplaced - Displacement does not increase with elbow flexion  Avulsion (displaced)  Oblique and Transverse (displaced)  Comminuted (displaced)  Fracture dislocation 
  8. 8. Schatzker Classification
  9. 9. AO Classifiation    Type A: extraarticular Type B: Intraarticular Type C: Intra-articular fractures of both the radial head and olecranon
  10. 10. Treatment  Goals:     Articular restoration Preservation of the extensor mechanism Elbow stability Avoidance of stiffness and maintain the range of motion
  11. 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. 12. Surgical procedures  Tension band wiring technique over two Kirschner wires
  13. 13.  Contoured plate application to the posterior aspect of the proximal ulna
  14. 14.  Intramedullary fixation
  15. 15.  Fragment excision and triceps reattachment
  16. 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. 17. Tension band technique  Fracture reduction
  18. 18.  Drilling
  19. 19.  Wire preparation and insertion
  20. 20.  First K-wire insertion
  21. 21.  Second K-wire
  22. 22.  Figure-of-eight configuration
  23. 23.  Tightening the wire
  24. 24.  Prevent later soft-tissue irritation
  25. 25.  Sinking the K-wires
  26. 26.  The end result
  27. 27. References:  AO Principles of Fracture Management: Thomas P. Ruedi , William M. Murphy  Rockwood and Green's Fractures in Adults  AAOS

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