Introduction

The olecranon process is a part of your ulna and is important to normal elbow and forearm function.  Fractures of the olecranon process are typically separated into low and high energy mechanisms of injury.  Relatively young patients typically sustain high energy injuries and examples would include motor-vehicle accidents, falls from height and injuries sustained during contact sport. Relatively older patients are more at risk for low energy injuries as typically sustained in falls from standing height.

Treatment

After sustaining an injury to their elbow patients are typically seen by a physician in the emergency room.  An olecranon fracture is diagnosed following a physical examination and x-rays of the injured arm. It is important for the entire elbow to be examined in the emergency department as olecranon fractures are sometimes found in association with other injuries. “Open” olecranon fractures (where the broken bone has come through the skin) are also not uncommon, especially in older patients with poor skin. Open injuries require early administration of antibiotics and potentially updating your tetanus prophylaxis to decrease the risk of developing an infection.

Following your initial assessment and diagnosis in the emergency department, an orthopaedic surgeon will be consulted to manage your definitive care. There are two broad categories for the treatment of olecranon fractures:

  1. Non-Operative Treatment: There are several types of olecranon fractures which may not be treated with an operation:
    • Non-Displaced Fractures: If your fracture is not shifted (displaced) and you are able to move your elbow through a range of motion without any displacement, then your fracture likely does not require surgery.
    • Avulsion Fractures: Occasionally a forceful eccentric contraction of your triceps can cause a small flake of bone to come free from the olecranon. This may represent a complete separation of your triceps muscle from the olecranon and you would require a different surgical procedure to address this. If your ability to straighten your elbow against resistance is not impaired, however, these injuries can be treated without surgery.
    • Elderly Patients: There is increasing evidence in the medical literature that elderly patients with relatively low functional demands with even displaced olecranon fractures can be treated without surgery and expect a good functional result.  Given that this is somewhat controversial at present, you will have to speak with your surgeon surrounding the risks and benefits of pursuing this treatment approach.
  2. Operative Treatment: The majority of patients with displaced olecranon fractures will be treated with an operation.  Surgery will be performed after you have been assessed by an orthopaedic surgeon had the chance to discuss the risks, benefits and potential alternatives to surgery. Surgery is usually performed within 7 – 10 days of your injury. Depending on factors including the fracture location, the number of fracture fragments and the quality of your bone your surgeon will choose the most appropriate implant to address your injury.

Expected Follow-Up:

  1. 0 – 2 Weeks: For the first 7 – 14 days following your injury and subsequent operation, you may be asked to wear a splint to protect your elbow. The purpose of this splint is not so much to help in bone healing but rather to decrease the stress on the skin and soft tissue around your elbow and avoid issues with your surgical incision. You will be re-assessed in fracture clinic at 7 – 14 days from your injury for an examination of your incision, removal of skin clips or sutures and a repeat x-ray.
  2. 2 – 6 Weeks: If no complications are identified at your first follow-up appointment, you will be asked to start working on regaining the normal range of motion in your injured elbow. Your elbow is very sensitive to prolonged periods of immobility so it is important to begin working at your range of motion as soon as possible to avoid developing painful elbow stiffness. At this early stage following your injury you will likely be asked to avoid any strengthening to decrease the risk of fracture displacement. A good general guide for the amount of weight you should be limiting yourself to in your injured arm is a cup of coffee. A follow-up appointment will be arranged at around six weeks from your initial injury.
  3. 6 – 12 Weeks: After your 6 week post-operative assessment you will continue to work on your range of motion and may now begin working at gentle strengthening of your injured arm. You will likely be referred to a physiotherapist at this point in your rehabilitation. As your strength improves and you are able to use your injured arm for more activities you will be transitioned back to work (if you have been away). If your recovery has been straight forward then the follow-up assessment at 12 weeks from your injury may be the final one. Additional follow-up may be indicated for more severe injuries of if there have been any complications.

Complications

An operation to fix an olecranon fracture is subject to standard surgical risks such as infection, injury to nerves and blood vessels, and risks associated with your anaesthetic.  Additionally, there are some risks that are unique to this particular operation:

  1. Stiffness: Any injury to the elbow is at risk for the subsequent development of post-traumatic elbow stiffness and arthritis and this includes olecranon fractures. Your active participation in rehabilitation following your injury is extremely important in maximizing your range-of-motion post-operatively.
  2. Hardware Irritation: Your olecranon is almost immediately under the skin and this places it at increased risk of hardware prominence and irritation post-operatively. The risk of hardware irritation is roughly the same regardless of the type of implant your surgeon chooses to address your particular fracture. If that hardware is particularly bothersome, it may be removed once the fracture is solidly healed.

Outcome

Patients with olecranon fractures can generally expect good to excellent outcomes once their fracture has gone on to heal. As with other elbow injuries, patients must be particularly engaged in their post-injury rehabilitation in order to maximize their range-of-motion and outcome. Hardware removal relatively common following successful fracture healing.