When you bend your elbow, you can easily feel its “tip,” a bony prominence that extends from one of the lower arm bones (the ulna). That tip is called the olecranon (oh-lek’-rah-nun). It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. It can easily break if you experience a direct blow to the elbow or fall on a bent elbow.
There are many types of elbow fractures (breaks). Olcranon fractures are common. Although they usually occur in isolation (that is, there are no other injuries), they can be a part of a more complex elbow injury.
Olecranon fractures can occur in a number of ways:
While in the emergency room, the doctor will treat an olecranon fracture with ice, pain medicine, a splint (like a cast), and a sling to keep the elbow in position.
Whether or not the fracture requires surgery will be determined. Not all olecranon fractures require surgery.
Some olecranon fractures require just a splint or sling to hold the elbow in place during the healing process. The doctor will closely monitor the healing of the fracture, and have the patient return to clinic for X-rays fairly frequently.
If none of the bone fragments are “out of place” after a few weeks, the doctor will allow the patient to begin gently moving the elbow. This may require visits with a physical therapist.
The patient will not be allowed to lift anything with the injured arm for a few weeks.
A nonsurgical approach to olecranon fracture may require long periods of splinting or casting. The elbow may become very stiff and require a longer period of therapy after the cast is removed to regain motion.
If the fracture shifts in position, the patient may require surgery to put the bones back together.
Surgery to treat an olecranon fracture is usually necessary when:
Surgery can be done under general anesthesia (going to sleep) or under regional anesthesia (using medicines like novocaine that numb the arm), or both.
The surgeon will typically make an incision over the back of the elbow and then put the pieces of bone back together. There are several ways to hold the pieces of bone in place. The surgeon may choose to use:
If some of the bone is missing or crushed beyond repair (pieces of bone lost through a wound during an accident), the fracture may require bone filler. Bone filler can be bone supplied by the patient (typically taken from the pelvis) or bone from a bone bank (from a donor), or an artificial calcium-containing material.
The incision is typically closed with sutures or staples. Sometimes, a splint is placed on the arm, but not always.
Considerations Surgery has some risks. If surgery is recommended, the doctor feels that the possible benefits of surgery outweigh the risks.
There is a risk of infection with any surgery, whether it is for an olecranon fracture or another purpose.
Pain is controlled in the operating room by an anesthesia team, who can either put the patient to sleep or numb the arm, or both. The doctor will discuss the method of anesthesia with the patient prior to surgery. After surgery, pain is controlled with a combination of pain medications.
Damage to nerves and blood vessels. There is a minor risk of damage to nerves and blood vessels around the elbow. This is an unusual side effect.
Surgery does not guarantee healing of the fracture. A fracture may pull apart, or the screws, plates, or wires may shift or break. This can occur for a variety of reasons, including: