Olecranon Fracture
Side view of the elbow joint, showing a broken olecranon
Several different fractures can occur around the elbow. One of the most common breaks around the elbow is at the pointy end of the elbow, a portion of the ulna bone called the “olecranon”. The elbow joint is made up of three bones, the 1) humerus (upper arm) which makes a hinge joint with the forearm bones – the 2) radius and 3) ulna bones. The portion of the ulna bone near the elbow is called the olecranon. This bone is right underneath the skin, and can be felt as the bony “tip” of the elbow.
Causes
Olecranon fractures usually occur following a direct fall onto the tip of the elbow, or can occur when the tip of the elbow is hit with a hard object.
Diagnosis
Olecranon fractures result in pain, bruising, swelling, and decreased motion. Patients usually have difficulty bending or straightening the elbow. The elbow may feel unstable, like it is popping out, or you may feel crunching with motion. Sometimes this injury can result in numbness and tingling into the small and ring finger – due to irritation of the nearly “ulnar nerve”. Occasionally the skin overlying the tip of the elbow can be torn, scraped, or cut – this can effect treatment, as it can make surgery more risky.
X-rays are essential for diagnosis of any elbow fracture. This degree of displacement, or shift of the fracture, can help to decide the best treatment option.
Treatment
Non-surgical treatment
Non-displaced or non-shifted fractures, breaks with notable injury to the skin overlying the elbow, or fractures in the elderly may be treated non-surgically with a splint and immobilization. Typically motion is started around ~3 weeks after the injury to decrease the risk of permanent stiffness. Displaced, or shifted fractures, may result in a “fibrous non-union”. This occurs when the bone fragments heal together with scar tissue instead of calcified bone. Fortunately, many patients will still have a pain free, movable, and very functional elbow.
Surgery
Most olecranon fractures are treated surgically. Breaks that extend into the elbow joint itself can lead to arthritis and pain; this risk can be minimized with surgery. Additionally, the triceps muscle inserts into the olecranon, which provides strength for extending and straightening the elbow. If age, health, and skin condition allow for surgery, this is usually the best option for optimizing function of the elbow and minimizing the risk of future pain.
Surgery, however, is not without risks. One of the concerns about elbow surgery is healing of the incision. This is because the olecranon bone, the tip of the elbow, sits just beneath the skin.
Typical post-surgery protocol involves a non-removable splint worn full time for 2 weeks after surgery. At this point, a removable splint is made which is worn at nighttime and for activities. After 2 weeks, the splint is removed for motion exercises throughout the day to minimize stiffness. Once the break had healed (typically ~6-8 weeks), the splint is discontinued, strengthening of the elbow begins, and activities are reintroduced as tolerated.
Occasionally, even if surgery and recovery goes well, the metal plate may bother individuals when leaning on the elbow. This can be removed if bothersome, but it is usually advised to wait ~1 year after surgery. This allows for maximal healing and to see if the patient and elbow acclimate to having the metal plate in place.
Patient 1: Olecranon open reduction internal fixation (ORIF)
Patient 2: Olecranon open reduction internal fixation (ORIF)
Two patient examples of olecranon fractures treated successfully with a metal plate and screws are shown in the images above. This technique aligns the fracture fragments, and allows for early motion of the elbow, which maximizes the chance for a pain free and normally bending elbow.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.