summary Olecranon Fractures are common fractures of the elbow that lead to loss of extensor mechanism. Diagnosis can be made with plain radiographs of the elbow. Treatment may be nonoperative for nondisplaced fractures with an intact extensor mechanism. Surgical management is indicated for displaced fractures or fractures associated with loss of extensor mechanism. Epidemiology Incidence 12 per 100,000 per year account for approximately 10% of upper extremity fractures Age mean age is ~57 years Bimodal distribution high energy injuries in the young low energy falls in the elderly Etiology Pathophysiology mechanism direct blow login to view 1 more bullet indirect blow login to view 2 more bullets Associated conditions Transolecranon fracture/dislocation severe axial load leading to potential instability of the ulnohumeral joint due to severe intra-articular comminution of the olecranon fracture considered an anterior dislocation of the elbow (distal humerus is driven through the olecranon) there is no disruption of the proximal radioulnar joint Anatomy Osteology together with coronoid process, forms the greater sigmoid (semilunar) notch greater sigmoid notch articulates with trochlea provides flexion-extension movement adds to stability of elbow joint Muscles triceps inserts onto posterior, proximal ulna blends with periosteum innervated by radial nerve (C7) anconeus inserts on lateral aspect of olecranon innervate by radial nerve (C7) Classification Mayo Classification Based on comminution, displacement, fracture-dislocation Colton Classification Nondisplaced - Displacement does not increase with elbow flexion Avulsion (displaced) Oblique and Transverse (displaced) Comminuted (displaced) Fracture-dislocation (Transolecranon) Schatzker Classification Type A Simple transverse fracture Type B Transverse impacted fracture Type C Oblique fracture Type D Comminuted fracture Type E More distal fracture, extra-articular Type F Fracture-dislocation AO Classification Type A Extra-articular Type B Intra-articular Type C Intra-articular fractures of both the radial head and olecranon Presentation Symptoms pain well localized to posterior elbow Physical exam palpable defect indicates displaced fracture or severe comminution inability to extend elbow indicates discontinuity of triceps (extensor) mechanism Imaging Radiographs recommended views AP/lateral radiographs login to view 1 more bullet additional views radiocapitellar may be helpful for login to view 2 more bullets CT indications may be useful for preoperative planning in comminuted fractures Treatment Nonoperative cast immobilization indications login to view 2 more bullets technique login to view 2 more bullets Operative open reduction internal fixation (ORIF) fixation techniques login to view 14 more bullets fragment excision and triceps advancement indications login to view 3 more bullets outcomes login to view 2 more bullets Techniques Open reduction internal fixation (ORIF) techniques tension band fixation login to view 10 more bullets plate fixation login to view 9 more bullets intramedullary fixation (IMN) login to view 3 more bullets Excision and triceps advancement technique triceps tendon reattached with nonabsorbable sutures passed through drill holes in proximal ulna Complications Symptomatic hardware most frequent reported complication Stiffness occurs in ~50% of patients usually doesn't alter functional capabilities Heterotopic ossification more common with associated head injury Posttraumatic arthritis Nonunion rare Ulnar nerve symptoms Anterior interosseous nerve injury Loss of extension strength