5 Things You Need to Know About Olecranon Fractures

1. Tip of the Ulna
When you feel the bony prominence in back of your elbow, that is the olecranon. It is the hinge portion of the elbow joint. The triceps muscle tendon attaches to the tip of the olecranon. That is why when you contract the triceps, it extends the elbow.
2. Fracture Can Lead to Loss of Elbow Function
The ability to actively straighten your elbow is an important part of everyday function. It allows you to reach away from the body to grab something. It allows you to push yourself up from a chair. It allows you to catch yourself when you misstep or fall. It allows you to play the drums. It allows you to raise your hand in class. It allows you to throw darts.
3. Function Determines Need for Surgery
Some nondisplaced fractures can be treated without surgery, if the ability to actively extend the elbow is retained. If this is the case, early motion in a brace can be started. Usually, active extension of the elbow is prohibited for 6 weeks. Otherwise, the pull of the triceps muscle would tend to pull the pieces apart. Active flexion and passive extension are allowed. This means that you allow either a therapist or the effect of gravity to straighten the elbow for you.
4. Surgical Options
One way of fixing an olecranon fracture is with a plate and screws. These hold the bones still while they are healing and counteract the deforming muscle forces across the fracture site. Some fracture patterns are amenable to a long screw and washer. The screw enters from the back of the bone, and the threads engage in the shaft where the bone narrows. A washer is usually used to spread out the forces on the back of the bone and to prevent cutout of the proximal piece. Another way of fixing this fracture is with a tension band construct. This uses a figure-of-8 loop of wire or suture to convert the distraction forces on the fracture to become compressive forces nearer the joint. Compression is desirable because it promotes bone healing. This is especially important nearer the joint.
5. Metal Hardware Must Be Removed
The olecranon is essentially subcutaneous, which means "right under the skin." When you feel the bone, there is no muscle there. It literally is "skin-and-bones" there. You can imagine a plate or screws or wires would be quite irritating. Each time you leaned on an armrest or rest your elbows on the table, you would feel the metal hardware. This can cause the bursa to become inflamed. Think of the bursa as a fluid-filled sac, which normally sits between the bone and the skin, that prevents the skin from chafing every time the elbow is bent. This bursa can become chronically irritated by the underlying metal hardware. Because of this, hardware removal can be performed by your surgeon once the bone is healed.