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Olecranon Fractures
Posted: Dec 2 2020 #(C101648)
A

Olecranon Fracture in 67F

HPI

67-year-old RHD female presents to the ED with complaints of left elbow pain following a ground level fall

PMH

No significant PMH

PE

Her physical exam shows tenderness to palpation about the left elbow. There are no open wounds. She has full range of motion of the wrist her cardinal hand motions are normal. Her sensation is intact to light touch throughout the hand. She has a 2+ radial pulse with good capillary reflex in all fingers.

Poll
1 of 10
1. In addition to AP and LAT radiographs of the injured elbow, would you obtain any additional imaging to guide management?
No - AP and LAT radiographs radiographs are sufficient
77%
699/903
Yes - Additional xray views (aXR)
2%
24/903
Yes - CT scan of the elbow (CT)
15%
144/903
Yes - MRI scan of the elbow (MRI)
1%
10/903
Yes - aXR + CT
0%
8/903
Yes - aXR + MRI
0%
4/903
Yes - aXR + CT + MRI
0%
2/903
Outside my area of expertise - best if I don't vote
1%
12/903
2. Would you use a classification system to guide management?
No - a classification system would not help me
66%
582/870
Yes - Mayo
9%
81/870
Yes - Colton
1%
17/870
Yes - Schatzker
3%
30/870
Yes - AO
12%
105/870
Yes - Other
0%
5/870
Outside my area of expertise - best if I don't vote
5%
50/870
3. How would you manage this patient?
Nonoperative
1%
16/876
Operative
97%
851/876
Outside my area of expertise - best if I don't vote
1%
9/876
4. If you choose Operative management, what treatment would you perform?
I would not choose Operative management
0%
5/862
External fixation Alone (monoplanar, ringed etc.)
0%
0/862
Percutaneous pinning Alone
1%
13/862
Open reduction internal fixation (ORIF) Alone (includes plate, tension band, intramedullary fixation)
95%
821/862
Excision and triceps advancement
0%
2/862
Other
0%
3/862
Outside my area of expertise - best if I don't vote
2%
18/862
5. If you choose Open reduction internal fixation (ORIF), what technique would you use?
I would not choose ORIF
0%
0/863
Tension band wiring (K-wires or suture band)
56%
485/863
Standard Plate (with screws)
26%
228/863
Intramedullary screw (includes tension banding to screw)
9%
79/863
Wire & Screw Device (e.g., Olecranon Sled Device)
4%
39/863
Suture anchor repair only
0%
4/863
Other
0%
8/863
Outside my area of expertise - best if I dont vote
2%
20/863
6. If you choose Open reduction internal fixation (ORIF) with Plate and screws, would you suture the triceps to the plate?
I would not choose ORIF with Plate and screws
31%
258/818
No
42%
349/818
Yes
22%
183/818
Outside my area of expertise - best if I don't vote
3%
28/818
7. If you choose Open reduction internal fixation (ORIF), would you perform ulnar nerve neurolysis?
I would not choose ORIF
1%
12/820
No
84%
692/820
Yes - in situ decompression only (no transposition)
9%
81/820
Yes - with ulnar nerve transposition
1%
14/820
Outside my area of expertise - best if I don't vote
2%
21/820
8. If you choose Operative management and obtained the construct shown below, would you immobilize the patient postoperatively, and if so, for how long before you start motion?
I would not choose Operative management
0%
1/778
I would not immobilize - begin immediate range of motion
32%
250/778
1-2 weeks (3-14 days)
50%
395/778
3-4 weeks (15-28 days)
11%
93/778
5-6 weeks (29-42 days)
2%
23/778
7-8 weeks (43-56 days)
0%
3/778
9-12 weeks (57-84 days)
0%
1/778
Outside my area of expertise - best if I don't vote
1%
12/778
9. If you choose Operative management and obtained the construct shown below, and elected NOT to immobilize postoperatively, what would be your immediate weight-bearing status?
I would not choose Operative management
0%
1/739
I would immobilize postoperatively
23%
176/739
Weight-bearing as tolerated
12%
91/739
Partial/protected (25-50%) weight-bearing
13%
97/739
Non-weight bearing
48%
360/739
Outside my area of expertise - best if I don't vote
1%
14/739
10. If you choose Operative management and obtained the construct shown below, and elected to Immobilize the patient postoperatively, how would you do it?
I would not choose Operative management
0%
3/744
I would not immobilize - begin immediate range of motion
24%
183/744
Posterior splint
55%
416/744
Hinged elbow brace
13%
101/744
Long arm cast
4%
33/744
Outside my area of expertise - best if I don't vote
1%
8/744
PROCEDURE #1

Open reduction and internal fixation of olecranon - CPT 24685

POLL#
Surgeon's Choices
1
In addition to AP and LAT radiographs of the injured elbow, would you obtain any additional imaging to guide management?
Yes - CT scan of the elbow (CT)
2
Would you use a classification system to guide management?
No - a classification system would not help me
3
How would you manage this patient?
Operative
4
If you choose Operative management, what treatment would you perform?
Open reduction internal fixation (ORIF) Alone (includes plate, tension band, intramedullary fixation)
5
If you choose Open reduction internal fixation (ORIF), what technique would you use?
Standard Plate (with screws)
6
If you choose Open reduction internal fixation (ORIF) with Plate and screws, would you suture the triceps to the plate?
Yes
7
If you choose Open reduction internal fixation (ORIF), would you perform ulnar nerve neurolysis?
No
8
If you choose Operative management and obtained the construct shown below, would you immobilize the patient postoperatively, and if so, for how long before you start motion?
1-2 weeks (3-14 days)
9
If you choose Operative management and obtained the construct shown below, and elected NOT to immobilize postoperatively, what would be your immediate weight-bearing status?
Non-weight bearing
10
If you choose Operative management and obtained the construct shown below, and elected to Immobilize the patient postoperatively, how would you do it?
Posterior splint
Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
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