The Olecranon is the part of the Ulna bone that is near the elbow joint, and is the superficial bone that you lean on when you rest your elbow on an armrest. Because it typically does not have much soft tissue coverage, it also is unfortunately easily broken when you happen to fall down on your elbow.
Patients typically have pain, swelling, and eventually bruising on the tip of the elbow especially with any range of motion. Typically patients will have difficulty or inability in extending the elbow, which also reproduces pain. Because of the proximity of the ulnar nerve, some patients may also have some loss of sensation in their little finger and half of their ring finger, and possibly some weakness in the fingers.
X-rays are normally ordered to determine whether there is a fracture and or other associated injuries. If the fracture pattern needs further investigation, a CAT Scan may be ordered, especially in those fractures that involve the joint. Also, an MRI may be ordered to help work up soft tissue and other pathology.
Olecranon fractures that are non-displaced can often be treated with immobilization either in a cast or splint for up to 6- 8 weeks. In general, it can take at least 6-8 weeks for the bone to heal, and an additional 6-8 weeks of physical therapy for the elbow to regain functional range of motion and use.
Surgery is carefully recommended based on a number of different variables, but is usually indicated for fractures that are displaced more than 2 mm at the joint, or where there is gapping at the fracture site, or inability to extend the elbow. Various treatment options are available in our armamentarium to fix Olecranon fractures, and includes plates, screws, and pins.
Elbow surgery is an area requiring special expertise in order to master because some elbow surgery is typically performed by hand surgeons, and others by sports surgeons, yet neither of them typically do a large quantity of elbow surgery. Dr. Steven Lee is uniquely fellowship trained in both hand/upper extremity surgery as well as sports medicine, and has is one of the most experienced orthopaedic surgeons for elbow surgery in NYC. He also regularly instructs courses teaching other orthopaedic surgeons on how to operate on the elbow. Learn about scheduling surgery.
All surgical patients are immediately immobilized in a non-removable splint from above the level of the elbow to the hand for 7-10 days following surgery. During this time, patients are encouraged to elevate their hand above their heart, keep their dressings clean and dry, and to move their fingers. Patients are allowed to use their fingers to text and type, but not to lift anything heavier than a cup of coffee or that which causes them more than a 2/10 pain level.
Patients will then be transitioned into a locked elbow brace and wrist immobilizer for 3-6 weeks. Depending on the stability of the fracture after it is fixed, the patient will be required to start occupational therapy (OT) as soon as possible to regain back strength and mobility. The fracture typically takes at least 6-8 weeks to heal, and therapy is often needed for at least 6 weeks.
Of note, the elbow is a particular area that can often become stiff with any trauma, including and especially Olecranon fractures, even when surgery is not required. The combination of trauma, surgery, and immobilization are all independent factors that cause stiffness, and therefore it is almost expected, even with optimal treatment with meticulous surgery and strict adherence to physical therapy protocols. It will be important for the patient to be very attentive to their instructions throughout the course of treatment to optimize the results.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.