Olecranon ( Elbow ) Fracture

When you bend your elbow, you can easily feel its “tip,” a bony prominence that extends from one of the lower arm bones (the ulna). That tip is called the olecranon (oh-lek’-rah-nun). It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can easily break if you experience a direct blow to the elbow or fall on a bent elbow.

• Sudden, intense pain

• Inability to straighten elbow

• Swelling over the bone site

• Bruising around the elbow

• Tenderness to the touch

• Numbness in one or more fingers

• Pain with movement of the joint

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

While in the emergency room, the doctor will treat an olecranon fracture with ice, pain medicine, a splint (like a cast), and a sling to keep the elbow in position.

Whether or not the fracture requires surgery will be determined. Not all olecranon fractures require surgery.

Nonsurgical Treatment

Some olecranon fractures require just a splint or sling to hold the elbow in place during the healing process. The doctor will closely monitor the healing of the fracture, and have the patient return to clinic for X-rays fairly frequently.

If none of the bone fragments are “out of place” after a few weeks, the doctor will allow the patient to begin gently moving the elbow. This may require visits with a physical therapist.

The patient will not be allowed to lift anything with the injured arm for a few weeks.

A nonsurgical approach to olecranon fracture may require long periods of splinting or casting. The elbow may become very stiff and require a longer period of therapy after the cast is removed to regain motion.

If the fracture shifts in position, the patient may require surgery to put the bones back together.

Surgical Treatment

Surgery to treat an olecranon fracture is usually necessary when:

• The fracture is out of place (“displaced”). Because the triceps muscles attach to the olecranon to help straighten the elbow, it is important for the pieces to be put together so you can straighten your elbow.

• The fracture is “open” (pieces of bone have cut the skin). Because the risk of infection is higher in an open fracture, the patient will receive antibiotics by vein (intravenous) in the emergency room, and may require a tetanus shot. The patient will promptly be taken to surgery so that the cuts can be thoroughly cleaned out. The bone will typically be fixed during the same surgery.

  Surgery can be done under general anesthesia (going to sleep) or under regional anesthesia (using medicines like novocaine that numb the arm), or both.

The surgeon will typically make an incision over the back of the elbow and then put the pieces of bone back together. There are several ways to hold the pieces of bone in place. The surgeon may choose to use:

• Pins/wires

• Screws only

• Plates and screws

• Sutures (“stitches”) in the bone or tendons

If some of the bone is missing or crushed beyond repair (pieces of bone lost through a wound during an accident), the fracture may require bone filler. Bone filler can be bone supplied by the patient (typically taken from the pelvis) or bone from a bone bank (from a donor), or an artificial calcium-containing material.

The incision is typically closed with sutures or staples. Sometimes, a splint is placed on the arm, but not always.