Pediatric emergency medicine trisk 3468 3468
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Olecranon fractures typically occur in conjunction with other elbow
injuries, notably a radial neck fracture or dislocation of the radial head
(Monteggia variant), or lateral condyle fracture.
Comparative views may be helpful in distinguishing the olecranon
growth plate from a fracture.
A missed fracture of the olecranon epiphysis can lead to a fixed flexion
deformity resulting in significant morbidity in adulthood.
The mechanism of an isolated olecranon fracture is hypothesized to be a sudden
flexion of the elbow when the triceps is strongly contracted (essentially an
avulsion injury), direct trauma, or stress fracture from repeated throwing activity.
Physical findings range from localized swelling to a marked hemarthrosis with
weak or absent elbow extension. Nondisplaced fractures may be somewhat
difficult to discern on the standard anteroposterior and lateral radiographs;
however, the presence of an abnormal fat pad should be viewed as presumptive
evidence of a bony injury ( Fig. 111.22 ). Olecranon fractures of <3 mm can be
stably splinted in partial extension and referred for outpatient orthopedic followup. Displaced fractures and stress fractures often require open reduction and
internal fixation. Immediate orthopedic consultation is indicated for displaced
fractures, open fractures, multiple fractures, and neurovascular injury. Isolated
olecranon fractures almost invariably heal quickly and without significant
complications.
Radial Head and Neck Fractures
CLINICAL PEARLS AND PITFALLS
