Figure 1. Anteroposterior radiograph of right elbow.
Figure 2. Lateral view of the right elbow.
A 78-year-old woman presents with right elbow pain after a fall that occurred 2 days earlier. She was unable to get off the floor after the fall and was brought to the emergency department via ambulance. Radiographs of the right elbow (Figures 1 and 2) show a displaced olecranon fracture. She is placed in a sling and instructed to follow up with orthopedics within the week. She is right-hand dominant and admits to a low activity level. Her preference is to not have surgery if she doesn’t have to.
Submit your diagnosis to see full explanation.
The olecranon is an attachment site for the triceps muscle and a critical component of the elbow extensor mechanism. The most common mechanism of injury that causes an olecranon fracture is a direct blow to the elbow. Nonoperative treatment is recommended for nondisplaced fractures.1 Surgery is recommended in most cases of displaced olecranon fractures.2 The most common surgical options include both plate fixation and tension band wiring. Fracture fixation is not without potential complications, however, which occur more often in older patients with poor skin and osteoporotic bone.2
Duckworth et al found that in low-demand older patients, nonoperative treatment of displaced olecranon fractures had similar short-and long-term outcomes compared with operative treatment.1 Nonoperative treatment of displaced fractures is the same as for nondisplaced fractures; the elbow is immobilized in 60 to 90 degrees of flexion for 2 to 3 weeks, followed by gentle motion and lifting restrictions until healing is present on radiograph. Weekly radiographs should be taken for the first 2 to 3 weeks to make sure further displacement doesn’t occur.1,2
The mean displacement in the aforementioned Duckworth study was 10 mm and greater displacement was associated with worse outcomes.1
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
1. Duckworth AD, Bugler KE, Clement ND, Court-Brown CM, McQueen MM. Nonoperative management of displaced olecranon fractures in low-demand elderly patients. J Bone Joint Surg Am. 2014;96(1):67-72. doi:10.2106/JBJS.L.01137
2. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001;15(8):542-548. doi:10.1097/00005131-200111000-00002