Olecranon fracture

definition

The Olecranon (German hook process) is the top (proximal) End of Cubit (Ulna). It represents the starting point of the Triceps brachii muscle The olecranon is part of the Elbow joint and articulates here with the joint role of the Humerus (Trochlea humeri).
The elbow joint (Articulatio cubiti) is a compound joint that consists of three parts. For one thing, ell and spoke a joint (proximal radioulnar joint), the humerus and the radius form another joint (Humeroradial joint) and finally the humerus and the olecranon articulate the ulna in the Humeroulnar joint.
The latter is a hinge joint with the forearm opposite the upper arm bent or stretched can be. An olecranon fracture is a fracture of the upper part of the ulna of the forearm.

causes

Usually one arises Olecranon fracture by direct force on the elbow, most often in the form of a Fall directly onto the elbow or less often by a blow.

Symptoms

In the case of an olecranon fracture, the Elbow massively swollen and with a bruise Mistake. The elbow starts to hurt a lot immediately after the injury. The approach of the Triceps muscle In the case of a fracture at the olecranon, the arm can no longer be actively extended in the elbow joint.
It is also characteristic that the pulling of the triceps muscle pulls the broken off piece of bone of the olecranon upwards, where it also closes Keys is. Likewise, a Gap at the elbow where the olecranon would otherwise be located. There is typically one painful restriction of movement.

diagnosis

Already through the anamnesis (Doctor consultation) the doctor receives initial information on the accidentthat may raise suspicion of an olecranon fracture. The one conspicuous during the inspection swelling, Blue color and painful restriction of movement corroborate the suspicion.
During the functional test, the doctor provides one lack of stretchability in the joint as well as a palpable gap. Furthermore, the broken off olecranon fragment can be felt further up by pulling the triceps muscle.
The doctor checks the forearm peripheral motor skills (force), sensitivity (sensation) and Blood circulation (Pulse) to prevent injuries from annoy or Vessels to exclude.

Imaging confirms the suspicion. Here comes one first X-ray for use. The recording is always made in two levelsso that the beam path runs from front to back and then from the side.
If there is a suspicion that there is an accompanying ligament injury, this can be with a Ultrasound examination or using "held recordings" be detected. This particular x-ray is the elbow joint laterally prestressedto get a increased opening to reveal damage to the stabilizing ligamentous apparatus.

Vascular injuries, on the other hand, can be identified relatively quickly; they are only rarely presented in the form of an angiography (X-ray representation of the vessels with contrast agent, CT or MRI) necessary.
All soft tissue injuries can generally be identified most reliably in an MRI. Accompanying nerve damage can sometimes only occur after weeks can be detected, whereby electro-neurography (CLOSELY) and electro-myography (EMG) have proven their worth.

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treatment

Treatment for an olecranon fracture is most common operational. Only with unshifted (undisplaced) Fractures in children the hernia can be treated conservatively, since their bone has another healing ability.
In this case, the immobilization is done by a so-called Gilchrist or Desault Association. The immobilization ensures that the bone parts grow together exactly.

However, all other fractures must be treated surgically. A distinction is made between simple avulsion fractureswhere the olecranon has simply broken through and the upper part is pulled up by the triceps muscle and Comminuted fractureswith the olecranon broken into several pieces.
When treating both fractures, access is from the spoke (radius) for the Ulnar nerve to protect. One of the important tasks of the ulnar nerve is the sensitive supply of parts of the Forearm and the hand, as well as the diffraction in wrist and the spread of the fingers.
The avulsion fracture is achieved using a Tension band osteosynthesis provided. With this technique, the tensile forces that pull the bone fragments apart are carried through Wire loops converted into compressive forces. The fractions are thus brought together and held in such a way that they can heal together again.

In the case of a comminuted fracture, the individual fracture fragments (Bone parts) stabilized by means of plate osteosynthesis. Come here small plates are used to fix the debris fragments together and hold them in the right position so that they can grow together. In both cases, the metal is usually removed in another minor surgical procedure removed again. This happens after the earliest 2 months. Depending on the extent of the fracture, a Immobilization to be necessary. Physiotherapy exercises can support mobility and counteract a loss of strength.

forecast

With adequate medical treatment and the right choice and implementation of the surgical technique, the chances of recovery from an olecranon fracture are very good. Essentially, the prognosis depends on the Extent of the fracture and the Injury to neighboring structures how Vessels, Musculature and Tendons or annoy from.
In the case of debris fractures, it can close despite careful surgical care Irregularities in the joint come. As a result, this can lead to Articular cartilage wear (arthrosis) or painful restrictions on movement to lead.
This can be problematic in stressful sports such as tennis, golf or rowing, and it affects joint but usually not in its everyday function. The operation itself can be classified as low-risk; important structures are injured, inflammation or wound healing disorders only rarely occur.

prophylaxis

By elbow pads the olecranon can be protected in particularly dangerous sports. The use is especially in sports such as Hockey, inline skating or polo advisable.