Introduction A rare elbow injury that predominately affects throwing athletes Epidemiology location predominantly involves the epiphyseal plate fractures lines may propagate to be either transverse or oblique in orientation 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 or splinting progressive ROM exercises avoiding valgus loading forces (e.g. throwing) electrical bone stimulation may also be considered 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 This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (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 Review Topic QID: 8685 FIGURES: A 1 cast immobilization for 6 weeks. 9% (6/65) 2 brief immobilization followed by rest for 6 weeks. 25% (16/65) 3 internal fixation with a compression screw. 40% (26/65) 4 internal fixation with a tension band wire. 20% (13/65) 5 bone stimulation. 5% (3/65) ML 4 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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? Review Topic QID: 1408 FIGURES: A 1 Elbow arthroscopy 1% (5/630) 2 Open removal of osteophytes 0% (3/630) 3 Ulnar nerve transposition 0% (1/630) 4 Internal fixation with a compression screw 94% (593/630) 5 Cast immobolization, followed by gradual return to strengthening program 3% (21/630) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 4
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 10/31/2017 52 views