[9] Olecranon Fractures Flashcards

1
Q

Describe the age distribution of olecranon process fractures?

A

They occur with a bimodal age distribution, occuring in the young and elderly (more common)

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2
Q

What do olecranon process fracture follow in the young?

A

High energy injuries

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3
Q

What do olecranon process fractures follow in the elderly?

A

Low energy indirect injuries

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4
Q

What is the olecranon?

A

The region of the proximal ulna from its top to the coronoid process

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5
Q

What does the olecranon process articulate with?

A

The trochlea of the distal humerus

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6
Q

What is the result of the olecranon articulating with the trochlear of the distal humerus?

A

All olecranon fractures are intra-articular by definition

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7
Q

What is the olecranon the site of?

A

Insertion for the triceps muscle

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8
Q

What do fractures of the olecranon typically result from?

A

Indirect trauma when a patient falls on an outstretched arm, resulting in a sudden pull of the triceps

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9
Q

How does the triceps muscle act on a olecranon fracture?

A

It further acts to distract the fracture

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10
Q

Why is it important to consider the role of the triceps in an olecranon fracture?

A

It influences the management of these injuries

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11
Q

How can olecranon fractures occur in younger patients?

A

Less commonly, it is due to high energy injuries resulting from direct trauma

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12
Q

What might olecranon fractures caused by high energy direct trauma be associated with?

A

Other foreaem injuries or fractures

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13
Q

How to olecranon fractures typically present?

A

History of falling on outstretched hand followed by elbow pain, swelling, and lack of mobility

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14
Q

What may be found on examination in elbow fractures?

A
  • Typically tenderness when palpating over the posterior aspect of the elbow, with a potential palpable defect present
  • Inability to extent elbow against gravity
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15
Q

Why is there an inability to extent the elbow against gravity in an olecranon fracture?

A

Due to disruption of the triceps mechanism

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16
Q

What might happen regarding extension of elbow against gravity in minimally displaced olecranon fractures?

A

Extension is preserved (albeit tender), due to soft tissue attachments that remain in tact

17
Q

What is it important to assess in examination of an olecranon fracture?

A

Neurovascular status of affected limb

18
Q

What other injuries may be associated with a fall on the outstretched hand?

A
  • Wrist (ligament and bony) injuries
  • Radial head fractures or dislocation
19
Q

What investigations should be performed in olecranon process fractures?

A
  • Routine blood tests
  • Imaging
20
Q

What should be included in blood tests in olecranon process fractures?

A

Clotting screen and group and save

21
Q

What initial imaging should be done in an olecranon process fracture?

A

Plain AP and lateral radiographs, of affected joint and potentially joints above and below too

22
Q

On what radiograph view are olecranon process fractures generally easily identifiable?

A

Lateral view

23
Q

Why do olecranon process fractures generally have a degree of displacement?

A

Due to the pull of the triceps

24
Q

Give two examples of classification systems used in describing olecranon fractures?

A
  • Mayo classification
  • Schatzker classification
25
Q

When might CT scanning be useful in olecranon process fractures?

A

In evaluating more complex injuries and degree of comminution

26
Q

How should olecranon process fractures be immediately managed?

A

Ensure the patient is resuscitated appropriately and stabilised prior to definitive management, and ensure to provide adequate analgesia

27
Q

What is treatment of olecranon process fractures guided by?

A

Degree of displacement on imaging

28
Q

What should warrant urgent senior discussion in olecranon process fractures?

A

Any complex injuries, such as fracture dislocations or neurovascular compromise

29
Q

What will management of olecranon process fractures often vary between?

A
  • Centre
  • Surgical preference
  • Patient factors
30
Q

What is non-operative management usually indicated for in olecranon process fractures?

A

Displacement <2mm

31
Q

What is involved in the non-operative management of olecranon process fractures?

A

Immobilisation in 60-90 degrees elbow flexion, and early introduction of range of motion at 1-2 weeks

32
Q

Who is there an increasing use of non-operative management for, irrespective of displacement?

A

All patients over 75

33
Q

Why is there an increasing use of non-operative management for all patients over 75 with an olecranon process fracture?

A

Because though the degree of extension may be lost, the functional outcome is often appropriate

34
Q

What is operative management of olecranon process fractures usually indicated by?

A

Disaplacement >2mm

35
Q

What techniques can be used in the operative management of olecranon process fractures?

A
  • Tension band wiring
  • Olecranon plating
36
Q

When will tension band wiring be used in olecranon process fractures?

A

If the fracture is proximal to the coranoid process

37
Q

When will olecranon plating be used in olecranon process fractures?

A

When the fracture is proximal to the coranoid process

38
Q

When will olecranon plating be used in olecranon process fractures?

A

If the fracture is at the level of, or distal to, the coranoid process

39
Q

Why is there a very high rate of removal of metalwork in olecranon process fractures?

A

Due to the very superficial nature of the injury, the metalwork often impacts the patient significantly