Elbow (Olecranon) Fractures – OrthoInfo

An olecranon (oh-LEK-rah-nun) fracture is a break in the bony tip of the elbow. This pointy segment of bone is part of the ulna, one of the three bones that come together to form the elbow joint.

The olecranon is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can break easily if you experience a direct blow to the elbow or fall onto the tip of the elbow. A fracture can be very painful and make elbow motion difficult or impossible.

Treatment for an olecranon fracture depends upon the severity of the injury. Some simple fractures can be treated by wearing a splint until the bone heals. In most olecranon fractures, however, the pieces of bone move out of place when the injury occurs. For these fractures, surgery is required to restore both the normal anatomy of the elbow and motion in the joint.

The olecranon (arrow) is the bony point of the elbow.

Your elbow is a joint made up of three bones:

• The humerus (upper arm bone)
• The radius (forearm bone on the thumb side)
• The ulna (forearm bone on the pinky side)

The elbow joint bends and straightens like a hinge. It is also important for rotation of the forearm; that is, the ability to turn your palm up (like accepting change from a cashier) or palm down (like typing or playing the piano).

The elbow consists of portions of all three bones:

• The distal humerus is the lower end of the humerus. It forms the upper part of the elbow and is the spool around which the forearm bends and straightens.
• The radial head is the knobby end of the radius where it meets the elbow. It glides up and down the front of the distal humerus when you bend your arm and rotates around the ulna when you turn your wrist up or down.
• The olecranon is the part of the ulna that cups the lower end of the humerus, creating a hinge for elbow movement. The bony point of the olecranon can easily be felt beneath the skin because it is covered by just a thin layer of tissue.

The elbow is held together by its bony architecture, as well as ligaments, tendons, and muscles. Three major nerves cross the elbow joint.

(Left) The bones of the elbow. The olecranon is the tip of the elbow and is part of the ulna.

(Right) The major nerves and ligaments are highlighted.

Olecranon fractures are fairly common. Although they usually occur on their own with no other injuries, they can also be part of a more complex elbow injury.

In an olecranon fracture, the bone can crack just slightly or break into many pieces. The broken pieces of bone may line up straight or may be far out of place (displaced fracture).

In some cases, the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the bone. This is called an open fracture. Open fractures are particularly serious because once the skin is broken, infection in both the wound and the bone are more likely to occur. Immediate treatment is required to prevent infection.

Olecranon fractures are most often caused by:

• Falling directly on the elbow
• Receiving a direct blow to the elbow from something hard, like a baseball bat, or a dashboard or car door during a vehicle collision.
• Falling on an outstretched arm with the elbow held tightly to brace against the fall. In this situation, the triceps muscle, which attaches to the olecranon, can pull a piece of the bone off of the ulna. Injuries to the ligaments around the elbow may occur with this type of injury, as well.

An olecranon fracture usually causes sudden, intense pain and can prevent you from moving your elbow. Other signs and symptoms of a fracture may include:

• Swelling over the tip or back of the elbow.
• Bruising around the elbow. Sometimes, this bruising travels up the arm toward the shoulder or down the forearm toward the wrist.
• Tenderness to the touch.
• Numbness in one or more fingers.
• Pain with movement of the elbow or with rotation of the forearm.
• A feeling of instability in the joint, as if your elbow is going to pop out.

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Physical Examination

Your doctor will talk with you about your medical history and general health and ask about your symptoms. They will then examine your elbow to determine the extent of the injury. During the exam, your doctor will:

• Check your skin for cuts, swelling, blistering, and bruising. In severe fractures, bone fragments can break through the skin, increasing the risk of infection.
• Palpate (feel) all around your elbow to determine if there are any other areas of tenderness. This could indicate other broken bones or injuries, such as a dislocated elbow.
• Check your pulse at the wrist to ensure that there is good blood flow to your hand and fingers.
• Check to see that you can move your fingers and wrist, and can feel things with your fingers.

Although you may have pain only at the elbow, your doctor may also examine your shoulder, upper arm, forearm, wrist, and hand to ensure that you do not have any other injuries.

X-rays

X-rays provide images of dense structures, such as bones. Your doctor will order X-rays of your elbow to help diagnosis your fracture. Depending on your symptoms, the doctor may also order X-rays of your upper arm, forearm, shoulder, wrist, and/or hand to determine whether you have other injuries.

This X-ray taken from the side shows an olecranon fracture in which the pieces of bone have moved out of place (displaced).

Reproduced from Konda SR: Fractures around the elbow, in Egol KA, Gardner MJ, eds: Let’s Discuss Management of Common Fractures. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2016, pp. 17-30.

While you are in the emergency room, your doctor will apply a splint (like a cast) to your elbow, and give you a sling to help keep the elbow in position. Immediate treatment may also include:

• Applying ice to reduce pain and swelling
• Medications to relieve pain

Your doctor will determine whether your fracture requires surgery. Many olecranon fractures will require surgery.

Nonsurgical Treatment

If the pieces of bone are not out of place (displaced), a fracture can sometimes be treated with a splint to hold the elbow in place during healing. During the healing process, your doctor will take frequent X-rays to make sure the bone has not shifted out of place.

You will typically wear a splint for 6 weeks before starting gentle motion. If the fracture shifts in position during this time, you may need surgery to put the bones back together.

(Left) The doctor will apply a splint that runs from near your shoulder all the way to your hand. (Right) An elastic bandage is applied to help keep the splint in place.

Surgical Treatment

Surgery is usually required for olecranon fractures in which:

• The bones have moved out of place (displaced fracture)
• Pieces of bone have punctured the skin (open fracture)

Surgery for olecranon fractures typically involves putting the broken pieces of bone back into position and preventing them from moving out of place until they are healed.

Because of the increased risk of infection, open fractures are scheduled for surgery as soon as possible, usually within hours of the diagnosis. Patients are given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury and the surfaces of the broken bone are thoroughly cleaned out. The bone will typically be repaired during the same surgery.

Surgical Procedures

Open reduction and internal fixation. This is the procedure most often used to treat olecranon fractures. During the procedure, the bone fragments are first repositioned (reduced) into their normal alignment. The pieces of bone are then held in place with screws, wires, pins, or metal plates attached to the outside of the bone.

Some common methods of internal fixation are shown below.

An olecranon fracture may be held together with pins and wires. This is called a tension band.

(Left) Reproduced from Boyer MI, Galatz LM, Borrelli J, Axelrod TS, Ricci WM: Intra-articular fractures of the upper extremity: new concepts in surgical treatment, in Ferlic DC, ed: Instr Course Lect 52. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003, pp. 591-605.

(Left) A single screw, placed into the center of the bone, may be used to keep the fractured bones together.
(Right) Plate(s) and screws may be used to hold the broken bones in place.

Bone graft. If some of the bone has been lost through the wound or is crushed, the fracture may require bone graft to fill the gaps. Bone graft can be taken from a donor (allograft) or from another bone in your own body (autograft). In some cases, an artificial material can be used instead of bone graft.

Complications of Surgery

There are risks associated with any surgery. If your doctor recommends surgery, they think that the possible benefits outweigh the risks.

Potential complications include:

Elbow stiffness. One of the most common problems patients face after any fracture around the elbow is stiffness. It is very important to begin physical therapy as directed to avoid elbow stiffness. In most cases, the 

Infection. There is a risk of infection with any surgery. Your doctor will take specific measures to help prevent infection.

Hardware irritation. A small percentage of patients may experience irritation from the metal implants used to repair the fracture.

Damage to nerves and blood vessels. There is a minor risk of damage to nerves and blood vessels around the elbow. This is an unusual side effect.

Nonunion. Sometimes, a fracture does not heal. The fracture may pull apart and the screws, plates, or wires may shift or break. This can occur for a number of reasons, including:

• The patient does not follow directions after surgery.
• The patient has a health problem, such as diabetes, that slows healing. Smoking or using other tobacco products also slows healing. Learn more: Smoking and Surgery
• If the fracture was associated with a cut in the skin (open fracture), healing is often slower.
• Infections can also slow or prevent healing.

If the fracture fails to heal, you may need further surgery.

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Pain Management

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and non-prescription pain medications are sufficient to relieve pain.

If your pain is severe, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.

Be aware that although opioids help relieve pain after surgery, opioid dependency and overdose have become critical public health issues. For this reason, opioids are typically prescribed for a short period of time. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve.

Rehabilitation

Whether your treatment is surgical or nonsurgical, full recovery from an olecranon fracture requires a good effort at rehabilitation.

Recovery After Nonsurgical Treatment

Because nonsurgical treatment can sometimes require long periods of splinting or casting, your elbow may become very stiff. For this reason, you may need a longer period of physical therapy to regain motion.

During rehabilitation, your doctor or a physical therapist will provide you with exercises to help:

• Improve range of motion
• Decrease stiffness
• Strengthen the muscles within the elbow

You will not be allowed to lift, push, or pull anything with your injured arm for a few weeks. Your doctor will talk with you about specific restrictions.

Recovery After Surgical Treatment

Depending on the complexity of the fracture and the stability of the repair, your elbow may be splinted or casted for a short period of time after surgery.

Physical therapy. Patients will usually begin exercises to improve motion in the elbow and forearm shortly after surgery, sometimes as early as the next day. It is extremely important to perform the exercises as often as directed. The exercises will only make a difference if they are done regularly.

Restrictions. You will not be allowed to lift heavy objects with your injured arm for at least 6 weeks. You will also be restricted from pushing and pulling activities, such as opening doors or pushing up while rising from a chair. You may be allowed to use your arm for bathing, dressing, and feeding activities. Your doctor will give you specific instructions. They will also let you know when it is safe to drive a car.

Even with successful treatment, some patients with olecranon fractures may experience long-term complications.

Loss of Motion

In some cases, a patient may not be able to regain full motion in the affected elbow. In most of these cases, the patient cannot fully extend or straighten their arm. Fortunately, the loss of a few degrees of straightening does not usually affect the overall function of the arm. Patients who have significant loss of motion may require intensive physical therapy, special bracing, or further surgery. This is uncommon for olecranon fractures.

Posttraumatic Arthritis

Posttraumatic arthritis is a type of arthritis that develops in a joint after an injury. Even when your bones heal normally, the cartilage lining the joint surfaces can be damaged, leading to pain and stiffness over time.

Posttraumatic arthritis is a relatively common complication of olecranon fractures. It can occur shortly after the fracture occurs or can take years to develop. Some patients with posttraumatic arthritis may need further surgery to relieve their symptoms. However, for many patients, there is little pain and no need for further treatment.

Most patients can return to their normal activities within about 4 months, although full healing can take more than a year. Recovering strength in your arm often takes longer than might be expected.

Although X-rays may show that the fracture has healed completely, some patients report that they still have limitations in movement. These patients will usually continue to improve over time.

Questions to Ask Your Doctor

If you experience an olecranon fracture, here are some questions you may wish to ask your doctor:

• When can I start moving my elbow?
• How soon can I resume my normal activities?
• What factors will prolong or delay healing?
• If I have to have surgery, what are the benefits and risks?
• What will my recovery be like?

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Elbow Fracture Open Reduction and Internal Fixation

What is elbow fracture open reduction and internal fixation?

Open reduction and internal fixation (ORIF) is a type of surgery used to
stabilize and heal a broken bone. You might need this procedure to treat
your broken elbow.

The elbow joint is a hinge type of joint composed of 3 bones. The humerus
(the upper arm bone) forms the joint with 2 bones of the forearm: the
radius and the ulna. The ulna forms the bony point of the elbow.

Different kinds of injury can damage any of the 3 bones that form the elbow
joint. This is especially common when you fall on an outstretched hand. The
bone may fracture into 2 or more pieces. In certain types of elbow
fractures, your bone has broken, but its pieces still line up correctly. In
other types of fractures (displaced fractures), the injury moves the bone
fragments out of alignment.

If you fracture your elbow, you might need ORIF to bring your bones back
into place and help them heal. During an open reduction,
orthopedic surgeons reposition your bone pieces during surgery, so they are
back in their proper alignment. In a closed reduction, a
doctor physically moves the bones back into place without surgically
exposing the bone.

Internal fixation
refers to the method of physically reconnecting the bones. This might
involve special screws, plates, wires, or nails that the surgeon places
inside the bones to fix them in the correct place. This prevents the bones
from healing abnormally. The entire operation usually takes place while you
are asleep under general anesthesia.

Why might I need an elbow fracture open reduction and internal fixation?

Certain medical conditions may make fracturing your elbow more likely. For
example, osteoporosis increases the risk of elbow fracture in many older
adults.

Not everyone with a fractured elbow needs open reduction and internal
fixation. In fact, most people don’t. If possible, your doctor will treat
your elbow fracture with more conservative treatments, like pain medicine,
splints, and slings.

You probably won’t need ORIF unless there is some reason your fracture
might not heal normally with these conservative treatments. You are likely
to need ORIF if:

• The pieces of your broken bone are significantly out of alignment
• Your broken bone pierced through your skin
• Your bone broke into several pieces

In these cases, ORIF can place your bones back into their proper
configuration. This significantly increases the chance that your bone will
heal properly.

You might need ORIF for a fracture that occurs anywhere in your elbow
joint, including the lower part of your humerus and the upper parts of your
radius or ulna.

What are the risks for an elbow fracture open reduction and internal
fixation?

Most people do very well with ORIF for their elbow fracture. Although rare,
complications can occur. Possible complications include the following:

• Infection
• Bleeding
• Nerve damage
• Joint stiffness (common)
• Joint instability
• Bone misalignment
• Complications from anesthesia
• Broken screws or plates
• Arthritis of the joint (months to years later)

There is also a risk that the fracture won’t heal properly, and you’ll need
a repeat surgery.

Your own risk of complications may vary according to your age, the anatomy
of your elbow fracture, and your other medical conditions. For example,
people with low bone mass or diabetes may be at greater risk of certain
complications. Smokers may also have an increased risk. Ask your doctor
about the risks that most apply to you.

How do I prepare for an elbow fracture open reduction and internal
fixation?

ORIF often takes place as an emergency or urgent procedure. Before your
procedure, a healthcare professional will take your medical history and do
a physical exam. You’ll need an image of your elbow, probably obtained with
an X-ray or magnetic resonance imaging (MRI). Tell your doctor about all
the medicines you take, including over-the-counter ones like aspirin. Also,
let your doctor know the last time you ate.

In some cases, your doctors might do your ORIF a little later. If so, talk
to your doctor about how to prepare for the procedure. Ask whether you
should stop taking any medicines ahead of time, such as blood thinners.
You’ll need to avoid food and drink after midnight the night before your
procedure.

What happens during an elbow fracture open reduction and internal fixation?

Your doctor can help explain the details of your particular surgery. The
details of your surgery will depend on the location and severity of your
injury. An orthopedic surgeon and a team of specialized healthcare
professionals will do the surgery. The whole operation may take a couple of
hours. In general, you can expect the following:

• You will receive general anesthesia, so that you’ll sleep through the
  operation and won’t feel any pain or discomfort during the procedure.
  (Or, you may receive a local anesthesia and a medicine to help you
  relax.)
• A healthcare professional will carefully monitor your vital signs, like
  your heart rate and blood pressure, during the operation. You may have
  a breathing tube inserted down your throat during the operation to help
  you breathe.
• After cleaning the affected area, your surgeon will make an incision
  through the skin and muscle of your elbow. (The specific site may vary
  according to the bone injured.)
• Your surgeon will bring the pieces of your fractured bone or bones back
  into alignment (reduction).
• Next, your surgeon will secure the pieces of the broken bone to each
  other (fixation). To do this, he or she may use
  screws, metal plates, wires, or pins. (Ask what the surgeon will use in
  your case.)
• Your doctor will make any other necessary repairs.
• After the team has secured the bone, your surgeon will surgically close
  the layers of skin and muscle around your elbow.

What happens after an elbow fracture open reduction and internal fixation?

Talk to your doctor about what you can expect after your surgery. You may
have some pain after your procedure, but pain medicine may help decrease
the pain. You should be able to resume a normal diet fairly quickly. You
will probably get an imaging test done, like an X-ray, to make sure the
surgery was successful. Depending on the extent of your injury and your
other medical conditions, you might be able to go home the same day.

For a while after your surgery, you’ll need to keep the arm immobile.
Often, this means you’ll need to wear a splint for several weeks. Make sure
to protect your splint from water. You’ll receive instructions about how
you can move your arm.

Your doctor might give you other instructions about caring for your arm,
like applying ice. Follow all your doctor’s instructions carefully. Your
doctor might not want you to take certain over-the-counter medicines for
pain, because some of these can interfere with bone healing. Your doctor
may advise you to eat a diet high in calcium and vitamin D as your bone
heals.

You might see some fluid draining from your incision. This is normal. Let
your doctor know right away if:

• You see an increase in redness, swelling, or draining from your
  incision
• You have a high fever or chills
• You have severe pain in your arm
• You have a loss of feeling in the arm or hand

Make sure to keep all of your follow-up appointments. You may need to have
your stitches or staples removed a week or so after your surgery.

At some point, you may need physical therapy to restore strength and
flexibility to your muscles. Doing your exercises as prescribed can improve
your recovery. Most people are able to return to most of their normal
activities within a few months.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications
  are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or
  problems
• How much will you have to pay for the test or procedure

fracture, dislocation, sprain, inflammation, arthritis / arthrosis, hygroma – Treatment and recovery

The elbow is a unique combination of three bones: the humerus, radius and ulna. This is a complex combined joint, which consists of three simple joints: humeroulnar, humeroradial, proximal radioulnar. All of them are united by one common capsule and joint bag (cavity). Inside the joint capsule, synovial fluid is constantly produced, which serves as a lubricant for the rubbing articular surfaces and nutrition for the anatomical parts. The ends of the bones are covered with a layer of periosteum, which helps protect and renew bone tissue, and also facilitates the flow of nutrients from the synovial fluid. All articular surfaces are covered with articular cartilage. The elbow joint is securely reinforced with ligaments and protected by a good muscular frame. These features allow you to perform four types of movements: extension and flexion, supination (rotation of the forearm at the elbow joint, in which it is possible to turn the hand palm up) and pronation (rotation of the forearm at the elbow joint, in which it is possible to turn the hand palm down). It is worth noting that the end of the ulna from above has an olecranon, resembling a hook in shape. The triceps muscle of the shoulder is attached to it. Fracture of this process is a fairly common injury.

Types of damage

The following categories of diseases are characteristic of the elbow joint:

• Traumatic
  • Bruises. The most common bruises are of the olecranon, periarticular tissues, condyles of the shoulder and ulnar nerve
  • Ligament sprains
  • Dislocations. There are: isolated dislocation and pronation subluxation of the radial head; dislocations of the forearm backwards, anteriorly, inwards, outwards; divergent dislocations with rupture of the proximal articulation and divergence of the bones of the forearm to the sides
  • Fractures of the bones of the elbow joint according to the nature of the damage can be divided into:
    • intra-articular;
    • periarticular;
    • closed;
    • open;
    • no offset;
    • with displacement of fragments (displacement of bone fragments most often occurs with fractures of the olecranon)
• Inflammatory
  • Epicondylitis (“tennis elbow”) is an inflammatory and degenerative disease that affects the tendons in the area of ​​the elbow joint due to chronic overload of the muscles of the forearm.
  • Styloiditis is a dystrophic-inflammatory process in the place where the tendon is attached to the process of the ulna.
  • Bursitis – inflammation of the joint capsule, which is located on the back of the elbow
  • Neuritis – ailments resulting from pinched nerve endings
  • Elbow tendinitis – inflammation in the tendons of the ulnar end of the triceps muscle
  • Arthritis – an acute inflammatory process in the articular cartilage and capsule without gross structural changes in the joint
• Arthrosis
  • Osteoarthritis is a dystrophic-degenerative disease of the cartilage and bone tissue of the joint.

Symptoms of pain

The main symptom of elbow disease is pain.

Traumatic group of injuries is characterized by the following signs:

• Stinging pain at the moment of injury
• Edema and hematoma in the area of ​​the elbow joint
• Elbow deformity
• Restriction in arm movements, partial or complete loss of limb function
• Or pathological mobility and the possibility of atypical movements for the elbow
• Numbness or tingling in the forearm, wrist, hand
• Squeak or click when moving the elbow
• Any discoloration of the skin in the affected area
• Perceptible protrusion of bone fragments under the surface of the skin

If any of the above symptoms should immediately seek help in the Department of Traumatology.

Which doctor to contact

To make an accurate diagnosis and prescribe the right treatment, you need to seek help from the following specialists:

• Traumatologist, orthopedist
• Surgeon
• Rheumatologist
• Neurologist

Highly qualified specialists are ready to receive you at the NCC Clinic No. 2 (Central Clinical Hospital of the Russian Academy of Sciences) in Moscow. You can make an appointment by phone +7 (499) 400-47-33

Diagnostics

Diagnostic activities include:

• Medical examination (palpation of the elbow joint area)
• Medical history taking
• Clinical and biochemical blood tests
• Urinalysis
• Ultrasound of elbow joints
• X-ray of the hand (two views)
• Computed tomography
• MRI

Treatment options

Treatment largely depends on the type and nature of the fracture in the elbow joint. Non-displaced fractures (such as those of the olecranon) can be treated conservatively by applying a fixing plaster cast for several weeks. If there is a displacement of the joint, then the issue of surgical intervention is decided. To do this, carry out the reposition of fragments (closed or open). With open comparisons, surgical fixation of fragments is mandatory, this operation is called osteosynthesis. Osteosynthesis is the connection of bone fragments with the help of special fixing means (bone grafts or metal structures). If fractures of the articular part of the humerus are fragmented, then it is possible to replace the elbow joint with a prosthesis. To restore the function of the elbow joint in deforming arthrosis, as well as in congenital and acquired deformities and contractures of other etiologies, osteotomy is currently performed. Osteotomy is a surgical operation that helps to eliminate the deformity of the elbow joint or improve the function of the musculoskeletal system by artificial fracture with further fixation to give a functionally advantageous position. After any surgical intervention, the patient is prescribed rehabilitation measures, compiled by the attending physician individually for each.

Home plaster cast treatment – Tartu Ülikooli Kliinikum

Kõrge kontrastsus

Tavaline kontrastsus

Suur

Tavaline

9000 2 Plaster cast or plaster splint is applied to the injured part of the body in order to immobilize it ( immobilization ) to heal injuries . After applying the cast, you will feel warm as it dries. The plaster cast dries and hardens in 24 hours. The duration of treatment with a plaster cast depends on the type of fracture and the doctor will inform you about this.

Care of the cast

• Do not wet the cast. When wet, the bandage will become soft.
• Do not go to the bath during treatment with a cast
• When showering, carefully cover the cast with polyethylene (eg cling film or plastic bag), which is secured around the edges with adhesive tape so that as little water as possible gets inside.
• If the cast becomes loose or dirty, bandage it over with a new bandage.
• Do not lean on the cast without permission from your doctor.
• Do not remove the cast without the doctor’s permission, even for a short time.

Care of an injured limb

• During a cast
  immobilization easily occur edema; they decrease if you hold the limb in
  elevated position, move your fingers or toes more often.
• To prevent the injured limb from losing muscle
  strength, start physical exercises with an immobilized limb after
  24 hours after applying a plaster cast. Tighten and relax your muscles under
  plaster so that they do not lose their strength. Fingers should be warm, mobile.
• The fracture often hurts
  the first days after applying a plaster cast; the pain will lessen if you keep
  limb in an elevated position and
  take painkillers.

• Cooling bags filled with ice are also used to reduce swelling and discomfort.