What's the Diagnosis? By Dr. Loran Hatch
Wed, 11/27/2019 - 9:00am
Editor:
A 60 yo F presents to the ED after a fall from height with pain in her L upper extremity. On exam, she is holding her L elbow in flexion. She has posterior elbow tenderness and swelling w/ decreased ROM, but is neurovascularly intact. A L elbow xray is obtained and shown below. What's the diagnosis? (scroll down for answer)
Answer: L olecranon fracture
- Represents ~10% of all upper extremity fractures
- Mechanism: direct force or fall with hyperextension/FOOSH
- Exam: localized tenderness/swelling of posterior elbow
- Mayo classification:
- Type 1: nondisplaced
- Type 2: displaced
- Type 3: unstable w associated injury +/- comminuted
- Treatment: immobilization w/ long arm posterior split w/ elbow in flexion
- Typically needs surgical repair
- Complications: decreased ROM (loss of extension), impaired tricep function, ulnar neuritis, heterotopic ossification, post-traumatic arthritis
References:
Baecher N and Edwards S. Olecranon Fractures. Journal of Hand surgery. 2013; 38(3): 593-604
Chow, Yvonne C.. "Elbow and Forearm Injuries." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016