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Olecranon Fractures
Posted: Jun 5 2020 #(C101487)
A

Olecranon fracture in 80F

HPI

An 80-year-old-female presents with left elbow pain following a ground-level fall. She is an active ambulator with a past medical history significant for diabetes and hypertension.

PMH

Diabetes, Hypertension

PE

On physical exam, there is no evidence of an open injury. On the left elbow, there is overlying ecchymosis, swelling, and tenderness to palpation. The left upper extremity is neurovascularly intact, with a palpable radial pulse and brisk capillary refill. Hand motor examination shows the EPL, FPL/FDP to the index finger, and her intrinsics, are all functioning normally.

Poll
1 of 10
1. Would you obtain any further imaging to guide management?
No - Current radiographs are sufficient
70%
1310/1858
Yes - Additional xray views
4%
81/1858
Yes - CT scan of the elbow (CT)
21%
396/1858
Yes - MRI scan of the elbow (MRI)
0%
8/1858
Yes - CT + Additional xrays
1%
33/1858
Yes - MRI + Additional xrays
0%
2/1858
Yes - MRI + CT + Additional xrays
0%
6/1858
Outside my area of expertise - best if I don't vote
1%
22/1858
2. Would you use a classification system to guide management?
No - a classification system would not help me
60%
1070/1770
Yes - Mayo
11%
205/1770
Yes - Colton
2%
39/1770
Yes - Schatzker
4%
75/1770
Yes - AO
16%
286/1770
Yes - Other
0%
6/1770
Outside my area of expertise - best if I don't vote
5%
89/1770
3. How would you manage this patient?
Nonoperative
13%
251/1814
Operative
85%
1542/1814
Outside my area of expertise - best if I don't vote
1%
21/1814
4. If you choose Nonoperative management, what form of immobilization would you choose?
I would not choose Nonoperative management
70%
1199/1697
Sling only
9%
153/1697
Removable splint
4%
79/1697
Hinged elbow brace
4%
84/1697
Long arm cast
9%
162/1697
Outside my area of expertise - best if I don't vote
1%
20/1697
5. If you choose Nonoperative management, when would you begin range of motion?
I would not choose Nonoperative management
65%
1100/1669
Immediately
5%
89/1669
1-2 weeks
9%
161/1669
3-4 weeks
11%
195/1669
5-6 weeks
4%
83/1669
7-8 weeks
1%
22/1669
9-12 weeks
0%
2/1669
Outside my area of expertise - best if I don't vote
1%
17/1669
6. If you choose Operative management, what surgery would you perform?
I would not choose Operative management
4%
84/1738
External fixation
0%
2/1738
Percutaneous pinning
3%
54/1738
Open reduction internal fixation (ORIF)
88%
1530/1738
Excision and triceps advancement
2%
42/1738
Outside my area of expertise - best if I don't vote
1%
26/1738
7. If you choose Open reduction internal fixation (ORIF), what technique would you use?
I would not choose ORIF
3%
61/1709
Suture anchor repair only
0%
17/1709
Tension band wiring (K-wires)
34%
591/1709
Intramedullary screw (includes tension banding to screw)
5%
95/1709
Plate and screws
52%
900/1709
Outside my area of expertise - best if I dont vote
1%
27/1709
Wire & Screw (e.g., Olecranon Sled Device)
1%
18/1709
8. If you choose Open reduction internal fixation (ORIF), would you perform ulnar nerve neurolysis?
I would not choose ORIF
2%
47/1652
No
84%
1389/1652
Yes
9%
159/1652
Outside my area of expertise - best if I don't vote
3%
57/1652
9. If you choose Open reduction internal fixation (ORIF) with Plate and screws, would you repair the triceps to the plate?
I would not choose ORIF with Plate and screws
15%
253/1632
No
51%
844/1632
Yes
29%
480/1632
Outside my area of expertise - best if I don't vote
3%
55/1632
10. If you choose Operative management and achieved the final construct shown in this case, how long would you immobilize the patient postoperatively?
I would not choose Operative management
3%
49/1630
No immobilization - immediate range of motion
26%
438/1630
Immobilize x1-2 weeks
46%
757/1630
Immobilize x3-4 weeks
17%
288/1630
Immobilize x5-6 weeks
3%
65/1630
Immobilize x7-8 weeks
0%
9/1630
Immobilize x9-12 weeks
0%
1/1630
Outside my area of expertise - best if I don't vote
1%
23/1630
PROCEDURE #1

Left olecranon ORIF with plate and screw fixation

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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