What are olecranon fractures?
On bending the elbow, it is the bony prominence that is felt extending from the lower arm bone called ulna. This is the tip of the elbow, and also known as the olecranon.
The elbow is a joint consisting of three bones - the humerus (upper arm between the shoulder and elbow), the radius (forearm bone between the elbow and wrist, on the lateral side, 'outside'), and the ulna (second forearm bone between the elbow and wrist, on the medial side or the 'inside'). The elbow joint is made up of portions of all three bones, and the olecranon is the part of ulna that 'cups' the end of the humerus and rotates around it like a hinge.
Positioned directly under the skin of the elbow, the olecranon is not protected by muscles and soft tissues and can easily break if a person falls or experiences a direct blow to the elbow, and this can lead to an elbow fracture.
What are the causes of an elbow fracture?
Among the many types of elbow fractures, olecranon fractures are fairly common. They generally occur in isolation, though they can also be part of a more complex elbow injury. Olecranon fractures can occur in the following ways:
- Direct blow to elbow - This happens if a person falls and lands hard directly on the elbow or is struck by a hard object. It is common during some form of sports or in a car accident.
- Impact on outstretched arm - An olecranon fracture may also occur if a person with an outstretched arm lands on the wrist, causing the triceps muscle on the back of the upper arm to pull the olecranon from its position.
What one needs to know about symptoms or signs?
- Sudden, intense pain
- Swelling
- Bruising around the elbow
- Tenderness
- Numbness in fingers
- Pain during movement of joint
- Inability to straighten elbow
Which specialist should be consulted in case of signs and symptoms?
An olecranon fracture requires immediate medical help at the hospital emergency room. An orthopaedic surgeon treats broken bone injuries.
What are the screening tests and investigations done to confirm or rule out the disorder?
The pain at the elbow joint can be very intense and the patient is usually unable to move. The patient must be taken to the hospital emergency room where the doctors conduct the following checks: Physical examination - Skin is examined for any cuts that could be caused by fragments of bone and could lead to infection. The doctor feels the elbow area to determine the extent of dislocation and gauge the area of tenderness, checks blood flow to the hand, along with the range of motion in the wrist and fingers. X-ray - An x-ray of the elbow is taken to confirm the fracture and reveal other dislocations. Additionally, the forearm, wrist and upper arm may also be scanned for other injuries or fractures.
What treatment modalities are available for management of the disorder?
First aid help requires treating the fracture with pain medication, ice, a splint and a sling to immobilize the elbow joint. The treatment plan involves:
Non-surgical treatment - Simply immobilizing the joint in a splint or sling can heal some olecranon fractures. If the fragments do not move from their original place in the next few weeks, the doctor may suggest starting physical therapy to regain movement in the elbow. Surgical treatment - If the fracture shifts in position or is open, surgery may be needed to put the bones back in their position. Displaced fracture - It is crucial for all olecranon fragments to be placed together in case they are displaced because the triceps muscles attached to the olecranon help straighten the elbow. Open fracture - Pieces of bone that cut through the skin increase the chances of infection. The patient is immediately taken into surgery to clean out the cuts and fix the bone in the same process.
Surgery may be performed under general or regional anaesthesia. With the patient lying on his/her back, side or stomach, the surgeon makes an incision over the back of the elbow to realign all pieces of the bone. These are held in place through pins or wires, screws or plates sutured into the bones or tendons. In case any fragment is missing or crushed, bone filler may be required; it is generally taken from the pelvis or created artificially using a calcium-containing material.
What are the known complications in management of the disorder?
Complications arising from surgery may include infection, pain (that can be controlled with medication) and damage to nerves and blood vessels.
Also, full motion of the elbow may not be regained even after the complete healing process. The patient may not be able to fully straighten his/her arm and may require intensive physical therapy, braces or further surgery to correct the issue.
A long-term outcome of olecranon fractures is elbow arthritis in which the elbow joint becomes stiff and painful. It occurs if the cartilage lining the elbow joint gets damaged from the fracture or if the fracture causes it to wear off over time.
What precautions or steps are necessary to stay healthy and happy during the treatment?
Treatment aims at recovering full motion of the elbow. Patients can return to full range of normal activities in few months' or a year's time. The elbow is placed in a splint or casted for a short time to provide comfort and promote healing. Patients must not lift objects using the injured arm for at least six weeks after the injury.
However, the doctor may suggest motion exercises for the elbow and forearm at the earliest. Physical therapy exercises are important for full recovery from an olecranon fracture, and once initiated, they must be performed every day to recover strength and motion.
Sources: "Elbow Injuries and Fractures," Patient.co.uk, https://www.patient.co.uk/doctor/Elbow-Injuries-and-Fractures.htm "Olecranon Fracture," Medscape.com, James W Pritchett, MD et al, https://emedicine.medscape.com/article/1231557-overview "Olecranon fractures," Radiopaedia.org, Dr David Blackmore and Dr Frank Gaillard et al, https://radiopaedia.org/articles/olecranon-fractures-1; Image courtesy: Wikipedia
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