summary Olecranon Stress Fractures are rare elbow injuries that predominately affects throwing athletes. Diagnosis can usually be made with plain radiographs of the elbow but may require an MRI or CT scan to confirm the diagnosis in the early stages. Treatment is generally rest from pitching, pain control, and brief period of immobilization. Epidemiology Anatomic location predominantly involves the epiphyseal plate fractures line may propagate to be either transverse or oblique in orientation Etiology Pathophysiology mechanism of injury three commonly accepted theories olecranon posteriomedial impingement triceps traction force valgus extension overload Associated injuries with throwing movements ulnar collateral ligament tears medial epicondyle avulsion fracture Presentation Symptoms posteromedial olecranon pain of the throwing arm improves with rest worse with throwing movements Physical exam inspection mild swelling over olecranon localized tenderness motion valgus instability stress test may indicate associated UCL injury Imaging Radiographs recommended views AP, lateral, oblique views of elbow optional views valgus stress views contralateral elbow for comparison findings physeal widening, delayed fusion, or fragmentation widening of the medial joint space with UCL injuries CT views best seen on lateral views findings typical fracture pattern originates from the articular surface runs toward the dorsal-proximal direction MRI indications suspected UCL tear views coronal T2 fat-saturated views findings T-sign indicative of UCL tears Treatment Nonoperative short-term administration of NSAIDS, rest +/- temporary splinting indications first-line treatment modalities initial 4-6 weeks of rest (removal from sport for up to 3 months) progressive ROM exercises avoiding valgus loading forces (e.g. throwing) electrical bone stimulation may also be considered consider vitamin D and calcium supplementation Operative open internal fixation indications delayed fracture union modalities large compression screw tension band wire
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07SM.23) Figure 7 shows the CT scan of a 22-year-old professional baseball pitcher who has had elbow pain for the past 6 months despite rest from throwing. Management should consist of QID: 8685 FIGURES: A Type & Select Correct Answer 1 cast immobilization for 6 weeks. 7% (35/499) 2 brief immobilization followed by rest for 6 weeks. 22% (111/499) 3 internal fixation with a compression screw. 54% (270/499) 4 internal fixation with a tension band wire. 12% (58/499) 5 bone stimulation. 5% (24/499) L 4 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ07SM.23) A 19-year-old college baseball player 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 management? QID: 1408 FIGURES: A Type & Select Correct Answer 1 Elbow arthroscopy 1% (13/1539) 2 Open removal of osteophytes 0% (3/1539) 3 Ulnar nerve transposition 0% (3/1539) 4 Internal fixation with a compression screw 95% (1463/1539) 5 Cast immobolization, followed by gradual return to strengthening program 3% (48/1539) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (1) Podcasts (0) Login to View Community Videos Login to View Community Videos 2016 Baseball Sports Medicine: Game Changing Concepts Elbow Stress Reactions: How to Best Treat Them - Lee D. Kaplan, MD (BSM #25, 2016) Lee Kaplan Shoulder & Elbow - Olecranon Stress Fracture E 10/31/2017 127 views 0.0 (0)