Updated: 6/5/2021

Olecranon Stress Fracture

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  • 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
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(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:
1

cast immobilization for 6 weeks.

6%

(23/406)

2

brief immobilization followed by rest for 6 weeks.

24%

(98/406)

3

internal fixation with a compression screw.

53%

(214/406)

4

internal fixation with a tension band wire.

12%

(50/406)

5

bone stimulation.

5%

(20/406)

L 4 E

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(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:
1

Elbow arthroscopy

1%

(13/1417)

2

Open removal of osteophytes

0%

(3/1417)

3

Ulnar nerve transposition

0%

(3/1417)

4

Internal fixation with a compression screw

95%

(1348/1417)

5

Cast immobolization, followed by gradual return to strengthening program

3%

(42/1417)

L 1 C

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