summary Olecranon Fractures are rare fractures in the pediatric population and most commonly occur as a result of fall onto an outstretched hand with the elbow in flexion. Diagnosis is made with plain radiographs. Treatment may be nonoperative for nondisplaced fractures with an intact extensor mechanism. Surgical management is indicated for displaced fractures or fractures associated with loss of extensor mechanism. Epidemiology Incidence uncommon fracture in children in the US, accounts for <5% of all pediatric fractures peak age between 5-10 year old Etiology Pathophysiology mechanism fall onto outstretched arm with login to view 6 more bullets direct trauma (least common) login to view 1 more bullet location metaphyseal (most common) physeal epiphyseal (apophyseal) login to view 2 more bullets Associated conditions osteogenesis imperfecta olecranon avulsion fractures are highly suspicious for osteogenesis imperfecta Anatomy Ossification centers of elbow age of ossification/appearance and age of fusion are two independent events that must be differentiated olecranon apophysis ossifies/appears at age 9 years fuses at age ~ 15 -17 years Olecranon ossification fusion of the epiphysis to the metaphysis of the olecranon occurs from anterior to posterior average age of closure is between the ages of 15-17 years old partial closure may be mistaken for olecranon fracture Ossification center of the Elbow Years at ossification (appear on xray) Years at fusion (appear on xray) Capitellum 1 12-14 Radial head 3 14-16 Internal (medial) epicondyle 5 16-18 Trochlea 7 12-14 Olecranon 9 15-17 External (lateral) epicondyle 11 12-14 Presentation History acute fall onto outstretched arm or direct elbow trauma Symptoms pain swelling of posterior elbow inability to extend elbow Physical exam inspection swelling and deformity contusion or abrasion over elbow may be suggestive of direct trauma palpation crepitus defect detected between fracture fragments gapping may suggest a disruption in the posterior periosteum, which makes the fracture more unstable movement lack of active elbow extension Imaging Radiographs recommended views AP and lateral elbow xrays findings fracture configuration (transverse, oblique, longitudinal) intra-articular displacement high suspicion for associated fracture (radial neck, lateral condyle, distal radius, etc.) proximal physis is oblique (green line) which differentiates it from a fracture (red line) secondary ossification center (patella cubiti) does not represent a fracture Treatment Nonoperative NSAIDS, rest, immobilization with avoidance of elbow resistance exercises indications login to view 2 more bullets outcomes login to view 2 more bullets long arm splint or casting indications login to view 1 more bullet duration login to view 2 more bullets Operative ORIF indications login to view 3 more bullets techniques login to view 11 more bullets Complications Nonunion Delayed Union Compartment syndrome Ulnar nerve neurapraxia due to pseudarthrosis with inadequate fixation Loss of Reduction Elbow stiffness