Review Question - QID 216550

The patient is presenting with a displaced olecranon fracture, which is best treated with a tension band construct with wires.

Olecranon fractures are relatively uncommon injuries in pediatric patients and most often occur with a fall on an outstretched hand with the elbow in a flexed position. Minimally displaced fractures and stress fractures can be treated with immobilization whereas displaced, unstable, and comminuted fractures are treated with open reduction and internal fixation. Fixation options include tension band constructs, plate constructs, and axial screws. The use of wires in tension band constructs has greater biomechanical stability and should be used in cases where greater loads on the construct are expected.

Cheng et al. performed a cross-sectional study of elbow radiographs of 1,577 pediatric patients and documented the radiographic appearance of the ossification centers. They reported no difference in timing of ossification between sexes and arm dominance. They concluded the sequence of ossification occurs as follows: capitellum, radial head, medial epicondyle, olecranon, trochlea, and lateral epicondyle.

Parent et al. performed a biomechanical analysis of olecranon fracture fixation with wire and suture tension bands. They reported higher residual fracture compression following cyclic loading and greater load-to-failure with wire constructs. The authors concluded wire tension band constructs have greater biomechanical stability than suture constructs for the treatment of olecranon fractures.

Figure A is a lateral radiograph of the left elbow with a displaced olecranon fracture.

Incorrect answers
Answer 1: An intramedullary lag screw would risk significant disruption of the physis and likely contribute to growth disturbance.
Answer 2: Splinting or casting would not be an acceptable treatment for a displaced olecranon fracture. A reduction with internal fixation must be performed.
Answer 3: A closed reduction and percutaneous pinning would not be an acceptable treatment option for this injury.
Answer 5: Fragment excision with triceps advancement is a treatment option for highly comminuted olecranon fractures in low-demand elderly patients with <50% involvement of the articular surface. This is not an acceptable option for a pediatric patient.