Olecranon Stress Fracture

Introduction

Injury is the result of:
- repetitive abutment of the olecranon into the olecranon fossa
- traction from triceps activity during the deceleration phase of the throwing motion
- impaction of the medial olecranon onto the olecranon fossa from valgus forces
fractures may be either transverse or oblique in orientation

Treatment

Nonoperative
- initial treatment consists of rest and temporary splinting
- electrical bone stimulation may also be considered
Operative
- open fixation with a large compression screw
  - indicated when nonsurgical management has failed to provide relief

TAG

(SBQ07.23) A 19-year-old college baseball has posterior elbow pain despite non-operative treatment for 9 months. He developed acute worsening of pain and inability to throw. His imaging is shown in Figure A. What is the next most appropriate step in managment? Topic

Review Topic

FIGURES: A

1. Elbow arthroscopy
2. Open removal of osteophytes
3. Ulnar nerve transposition
4. Internal fixation with a compression screw
5. Cast immobolization, followed by gradual return to strengthening program

PREFERRED RESPONSE ▶

DISCUSSION: Athletes may develop an olecranon stress fracture as seen in Figure A. Initially, this is treated with rest from activity. If it does not go onto union, ORIF with a compression screw is indicated. This injury is commonly seen in baseball pitchers as well as other higher-level athletes and is thought of as an overuse-type injury. This is part of the valgus-extension overload syndrome. Before it displaces, most of them are treated with a single large screw. Once it is displaced, it can be treated as any olecranon fx is treated (screw +/- tension band, or plate fixation).

The referenced study by Rettig et al is a case series of five pitchers who underwent ORIF with a 7.0mm screw for this pathology. All went onto successful union at a mean of 15.4 weeks with return to throwing at a mean of 29.4 weeks.

Illustration A depicts a compression screw and tension band construct with healed olecranon stress fracture.

Illustrations: A

REFERENCES:

1. Rettig AC, Wurth TR, Mieling P. Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes. Am J Sports Med. 2006 Apr;34(4):653-6. PMID:16556755 (Link to Abstract)

2. Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 101-111

Question Authors:

Patrick McCulloch MD, Ben Taylor MD, Michael Hughes MD, Eric Shirley MD,

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Level of Evidence 4 (Case Series)

Rettig AC, Wurth TR, Mieling P. Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes. Am J Sports Med. 2006 Apr;34(4):653-6. PMID:16556755 (Link to Abstract)

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Garrick JG (ed): Orthopaedic Knowledge Update: Sports Medicine 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2004, pp 101-111

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