Introduction Epidemiology incidence uncommon fracture in children in the US, accounts for <5% of all pediatric fractures peak age between 5-10 year old Pathophysiology mechanism fall onto outstretched arm with elbow in flexion will lead to triceps tensioning causing an olecranon avulsion fracture elbow in extension can lead to varus/valgus bending forces through the olecranon causing oblique fracture lines direct trauma (least common) location metaphyseal (most common) physeal epiphyseal (apophyseal) intra-articular extra-articular 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 Ossification center Years at ossification (appear on xray) (1) Years at fusion (appear on xray) (1) Capitellum 1 12-14* Radius 3 14-16 Internal (medial) epicondyle 5 16-18 Trochlea 7 12-14* Olecranon 9 15-17 External (lateral) epicondyle 11 12-14* (1) +/- one year, varies between boys and girl. C-R-I-T-O-E to remember age of ossification. CTE-R-O-I to remember age of fusion (capitellum, trochlea and external (lateral) epicondyle fuse together at puberty. Together they fuse to the distal humerus between the ages of 14-16 years old) 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 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 xrays that should always be obtained on evaluation findings fracture configuration (transverse, oblique, longitudinal) intra-articular displacement associated fracture (radial neck, medial/lateral condyle, distal radius, etc.) Treatment Nonoperative NSAIDS, rest, immobilization with avoidance of elbow resistance exercises indications partial stress fractures outcomes monitor until there is clinical improvement convert to casting if needed long arm splint or casting indications minimally displaced fractures integrity of posterior olecranon periosteum maintained duration 3-4 weeks total repeat imaging at 7-10 days to ensure no significant displacement Operative ORIF indications displaced fractures techniques tension band wiring AO technique with axial K-wires congruent articular surface consider early range of motion post-operatively tension band suturing use absorbable sutures (e.g. Number 1 polydioxanone (PDS) suture) may combine with oblique cortical lag screw with PDS with metaphyseal fractures plate and screws considered with comminuted fractures with partially fused ossification centers Complications Nonunion Delayed Union Compartment syndrome Ulnar nerve neurapraxia due to pseudarthrosis with inadequate fixation Loss of Reduction Elbow stiffness
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for Virtual Curriculum Members Only Click here to purchase (OBQ05.10) The injury pattern seen in Figure A following minimal trauma is consider to be highly suspicious of which of the following conditions? Review Topic QID: 47 FIGURES: A 1 Osteogenesis imperfecta 70% (2738/3931) 2 Neurofibromatosis 2% (59/3931) 3 Osteosarcoma 0% (17/3931) 4 Non-accidental injury 26% (1021/3931) 5 Aneurysmal bone cyst 2% (81/3931) Select Answer to see Preferred Response PREFERRED RESPONSE 1
fracture olecranon (C1130) Pediatrics - Olecranon Fractures - Pediatric HPI - 8 years boy with history of full down over Rt elbow since 3 days presented with complain of pain & swelling and limitation of movement over Rt elbow What is the optimal treatment for this pediatric olecranon fracture? 1/16/2012 138 6 6