synonyms: Pediatric Olecranon fracture, Olecranon stress fracture, olecranon apophysis
Pediatric Olecranon Fracture ICD-9
- 813.01(closed fracture of olecranon process of ulna)
- 813.11(open fracture of olecranon process of ulna)
Pediatric Olecranon Fracture Etiology / Epidemiology / Natural History
- Repeated forceful triceps contracture in children with open physes can lead to olecranon apophysis.
- Repeated forecful triceps contracture in adolescents with closed physes can lead to olcranon stress fracture.
Pediatric Olecranon Fracture Anatomy
Pediatric Olecranon Fracture Clinical Evaluation
- Pain and swelling in posterior elbow, weakness, decreased ROM.
- Posterior olecranon tenderness.
- Pain with resisted extension. Inability to extend in displaced fractures.
- Throwing athlete: symptoms worse in acceleration and follow-through phases of throwing.
Pediatric Olecranon Fracture Xray / Diagnositc Tests
- A/P, Lateral and oblique elbow xrays. Demonstrates widening and fragmentation and sclerosis of the olecranon physis in patients with apophysitis or stress fracture. Best assessed with comparision views of normal side. Displaced fractures are best seen on the lateral view.
- MRI: consider for patients with normal xrays with high concern for apophysitis or stress fracture:
- Bone scan: consider if MRI unavailable.
Pediatric Olecranon Fracture Classification / Treatment
- Acute Apophysitis/stress fracture: Activity modification, NSAIDs, ice, physical therapy. Generally resolves over 4-8 weeks.
- Chronic Apophysitis/stress fracture (failure to improve with 3months conservative treament): 6.5mm/7.3mm cannulated screw intrameduallary placement crossing the physis.
- Nondisplaced Olcranon fracture (<2mm): LAC.
- Displaced Olecranon fracture: if displaced, extensor mechanism is disrupted and fixation is indicated. Strongest construct=oblique screw across fx with tension band (Murphy, CORR 224:210;1987) using heavy absorbable sutures (allowed because healing is rapid in pediatric pts) Once fx is healed screw is removed. Screw across apophysis has not been shown to produce any significant growth disturbance. Two parallel pins require more dissection for removal. Consider open reduction, percutaneous pins and absorbable suture (Gortzak Y, JPP 2006;26:39).
Pediatric Olecranon Fracture Associated Injuries / Differential Diagnosis
Pediatric Olecranon Fracture Complications
Pediatric Olecranon Fracture Follow-up Care
- Once fx is healed screw is removed. Screw across apophysis has not been shown to produce any significant growth disturbance. Two parallel pins require more dissection for removal.
Pediatric Olecranon Fracture Review References