Olecranon Fracture ORIF 24685

Olecranon Fracture xray

proximal ulna anatomy picture

olecranon fracture ORIF xray

synonyms:olecranon fracture ORIF, elbow fracture ORIF

Olecranon Fracture ORIF CPT

Olecranon Fracture ORIF Anatomy

Olecranon Fracture ORIF Indications

  • Displaced olecranon fracture

Olecranon Fracture ORIF Contraindications

  • Active infection
  • Medically unstable for sugery

Olecranon Fracture ORIF Alternatives

  • Non-operative treatment
  • External Fixation

Olecranon Fracture ORIF Pre-op Planning

  • Consider using pre-countoured plates
  • For fractures with comminution, radiocapitellar or transolecranon instability, articular marginal impaction should be treated with Plate fixation.
  • Consider a tension band wire construct for simple fracture patterns without comminution.
  • Consider excision and triceps advancement in elderly, low-demand patients with small unreconstructable fracture patterns without associated elbow instability.

Olecranon Fracture ORIF Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Midline posterior incision curved around the olecranon. 
  • Fracture opened and hematoma debrided.
  • Anatomic reduction with large tenaculum clamp.  Consider drill hole in dorsal ulna to provide anchor point for clamp. 
  • Place two parallel 0.062 or 0.045 k-wires obliquely from proximal ulna, across fracture site and into the anterior ulnar cortex.  Back them up 5mm to allow later impaction. 
  • Place 2.5mm drill hole transversely across triangular ulna diaphysis distal to the fracture and anterior enough to be bicortical.
  • Place one 18-gauge wire or two 22-gauge wires (using two tranvserse distal drill holes) in figure-8 fashion through transverse hole and under the triceps insertion and k-wires proximally.  
  • Tighed the wires both medially and laterally.  Trim twisted ends and bend into the adjacent soft tissue.
  • Bend k-wires and cut excess. 
  • Incise triceps and impact bent ends into the proximal ulna with bone tamp. 
  • Irrigate.
  • Close in layers.

Olecranon Fracture ORIF Complications

Olecranon Fracture ORIF Follw-up care

  • Post-op: Place in posterior splint in 50-70º of flexion. Encourage finger ROM.
  • 10-14 Days: Wound check, remove staples. Evaluate reduction on xrays. Place in long-arm cast or removable posterior splint depending on fracture type and strength of fixation.
  • 6 Weeks: Wound check, evaluate xrays for callus formation. Place in removable posterior splint and begin elbow ROM exercises.
  • 3 Months: Evaluate xrays for fracture union. Begin gentle sport specific exercises depending on fracture union. Consider bone stimulator if union not evident on xrays.
  • 6 Months: Evaluate xrays. Return to sport.
  • 1Yr: Evaluate xrays. Evaluate xrays using Elbow Outcome Measures. May consider Hardware Removal if hardware is painful.

Olecranon Fracture ORIF Outcomes

  • (Bailey CS, JOT 2001;15:542).
  • (Karlsson MK, CORR 2002;403:205).

Olecranon Fracture ORIF Review References