Olecranon Fracture S52.023A 813.01

synonyms: elbow fracture, olecranon Fracture 

Olecranon Fracture ICD-10

• S52.021A - Displaced fracture of olecranon process without intraarticular extension of right ulna, initial encounter for closed fracture
• S52.022A - Displaced fracture of olecranon process without intraarticular extension of left ulna, initial encounter for closed fracture
• S52.023A - Displaced fracture of olecranon process without intraarticular extension of unspecified ulna, initial encounter for closed fracture
• S52.024A - Nondisplaced fracture of olecranon process without intraarticular extension of right ulna, initial encounter for closed fracture
• S52.025A - Nondisplaced fracture of olecranon process without intraarticular extension of left ulna, initial encounter for closed fracture
• S52.026A - Nondisplaced fracture of olecranon process without intraarticular extension of unspecified ulna, initial encounter for closed fracture

Olecranon Fracture ICD-9

• 813.01(closed fracture of olecranon process of ulna)
• 813.11(open fracture of olecranon process of ulna)

Olecranon Fracture Etiology / Epidemiology / Natural History

• Common causes: MVA, falls directly onto posterior elbow

Olecranon Fracture Anatomy

• see also Elbow Anatomy.

Olecranon Fracture Clinical Evaluation

• Pain, swelling in elbow.
• Document NV exam.
• Document wrist evaluation.

Olecranon Fracture Xray / Diagnositc Tests

• A/P, lateral and oblique elbow films. Fracture is best visualized on lateral film.

Olecranon Fracture Classification / Treatment

• Nondisplaced: sling immobilization followed by gentle ROM initiated within 10 days. Consider initially long arm casting for 4 weeks or ORIF depending of patient and fracture severity. Initially weekly xrays indicated to ensure fracture remains reduced.
• Displaced Young/high-demand: ORIF
• Displaced Elderly/low-demand: ORIF vs excision with triceps advancement.
• Olecranon Stress Fracture: generally associated with throwning sports, baseball. Treatment: rest and temporary splinting. Consider electrical stimulation. ORIF indicated after failure of nonoperative treatment. (Ahmad CS, Clin Sports Med 2004;23:665).
• Trans-olecranon fracture-dislocation: Treatment = ORIF.  (Mortazavi SM, Injury. 2006 Mar;37:284, Ring D, JOT. 1997;11:545)

Olecranon Fracture Associated Injuries / Differential Diagnosis

• Elbow dislocation
• Distal humerus fracture
• Radial head fracture
• Monteggia Fracture

Olecranon Fracture Complications

• Superficial wound infection
• Contracture
• Nonunion
• Hardware failure
• Malunion
• Painful hardware: occurs in 50%-80% of patients after olecranon fracture fixation. (tension band wiring frequently requires removal) (Karlsson MK, JSES 2002;11:377).
• Ulnar nerve palsy

Olecranon Fracture Follow-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 removali f hardware is painful.
• (Bailey CS, JOT 2001;15:542).
• (Karlsson MK, CORR 2002;403:205).

Olecranon Fracture Review References

• Egol KA and Koval KJ in Fractures in Adults, 6th ed, 2006
• Rockwood and Green's Fractures in Adults: 2009
• Operative Elbow Surgery: Expert Consult: 2012
• AAOS/ASES Advanced Reconstruction Elbow, 2007
• Orthopaedic Knowledge Update: Shoulder and Elbow 3, 2008
• Veillette CJ, Steinmann SP. Olecranon fractures. Orthop Clin North Am. 2008 Apr;39(2):229-36
• Mortazavi SM, Asadollahi S, Tahririan MA. Functional outcome following treatment of transolecranon fracture-dislocation of the elbow. Injury. 2006 Mar;37(3):284-8.
• Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Orthop Trauma. 1997 Nov;11(8):545-50.