Olecranon FracturesOlecranon Fractures

By: Christine Davis By: Christine Davis

http://www.youtube.com/watch?http://www.youtube.com/watch?v=hVc3NQhAw_I&NR=1v=hVc3NQhAw_I&NR=1

Common Mechanism Common Mechanism

Falling on flexed elbow when triceps are Falling on flexed elbow when triceps are contracted to help break the fall. contracted to help break the fall. Commonly an avulsion fracture Commonly an avulsion fracture

Direct blow to elbowDirect blow to elbow Elbow hyperextension Elbow hyperextension

Classification of Classification of Olecranon Fractures Olecranon Fractures

Schatzker Classification Schatzker Classification Transverse transverse impacted Transverse transverse impacted ObliqueOblique

Comminuted Oblique distal Comminuted Oblique distal Fracture Dislocation Fracture Dislocation

Treatment GoalsTreatment Goals

Alignment Alignment Articular restoration Articular restoration

Stability Stability Relationship between humerus and ulna Relationship between humerus and ulna

Treatment Treatment

Closed Reduction and Splint or Cast Closed Reduction and Splint or Cast Used for non-displaced, stable fractures.Used for non-displaced, stable fractures. Elbow should be held in 90 degrees flexion Elbow should be held in 90 degrees flexion

for 4 weeks. for 4 weeks.

Treatment Cont. Treatment Cont.

Open Reduction and Internal Fixation (ORIF)Open Reduction and Internal Fixation (ORIF) Recommended if less than 45 degrees of flexion is Recommended if less than 45 degrees of flexion is

required to maintain reduction required to maintain reduction Method of choice for displaced and comminuted Method of choice for displaced and comminuted

fracturesfractures Fixation MethodsFixation Methods

Large intramedullary screw Large intramedullary screw Tension band Tension band K-wires K-wires Plate & screw Plate & screw Combination Combination

Day One to Week One Day One to Week One

StabilityStability: NONE: NONE ROMROM: :

Surgical: Gentle elbow flexion and AROM in wrist Surgical: Gentle elbow flexion and AROM in wrist Cast: No ROM to elbow or wrist Cast: No ROM to elbow or wrist

StrengthStrength: Isometric wrist strengthening in cast : Isometric wrist strengthening in cast after 3-4 days. after 3-4 days.

Functional ActivitiesFunctional Activities: Only one armed : Only one armed activities with uninjured arm. activities with uninjured arm.

Week 2Week 2

StabilityStability: None to minimal: None to minimal ROMROM: :

Surgical: Active elbow flexion and AROM in wrist Surgical: Active elbow flexion and AROM in wrist Cast: No ROM Cast: No ROM

StrengthStrength: No strength to elbow in extension. : No strength to elbow in extension. Isometric to elbow and wrist. Isometric to elbow and wrist.

Functional ActivitiesFunctional Activities: Only one armed : Only one armed activities with uninjured arm. activities with uninjured arm.

Four to Six Weeks Four to Six Weeks

StabilityStability: Usually stable with bridging : Usually stable with bridging calluscallus

ROMROM: Active ROM in flexion and : Active ROM in flexion and extension extension

StrengthStrength: Isometric exercises in flexion : Isometric exercises in flexion and extension and extension

Functional ActivitiesFunctional Activities: May use affected : May use affected arm for stability and light self care. arm for stability and light self care.

Six to Eight Weeks Six to Eight Weeks

Stability: Stable Stability: Stable ROM: Full AROM to AAROM in all planes ROM: Full AROM to AAROM in all planes

to elbow and wristto elbow and wrist Strength: Resistive exercise to elbow and Strength: Resistive exercise to elbow and

wristwrist Functional Activities: May use affected Functional Activities: May use affected

arm for everyday activities arm for everyday activities

Eight to Twelve Weeks Eight to Twelve Weeks

Stability: StableStability: Stable ROM: Full AROM and AAROM in all ROM: Full AROM and AAROM in all

planes to elbow and wrist. planes to elbow and wrist. Strength: Resistive exercise to elbow and Strength: Resistive exercise to elbow and

wristwrist Functional Activities: May use injured Functional Activities: May use injured

arm for everyday activities arm for everyday activities

Expected Time LostExpected Time Lost

Expected time of bone healing:Expected time of bone healing: 10-12 weeks 10-12 weeks

Expected duration of rehabExpected duration of rehab 10-12 weeks 10-12 weeks

Muscle Strengthening Muscle Strengthening

Elbow Muscles Elbow Muscles Triceps Triceps Biceps Biceps PronatorsPronators Supinators Supinators

Wrist FlexorsWrist Flexors Flex. Carpi Radialis Flex. Carpi Radialis Flex. Carpi Ulnaris Flex. Carpi Ulnaris Flex. Digitorum longus and sublimis Flex. Digitorum longus and sublimis

Muscle Strengthening Muscle Strengthening Cont. Cont.

Wrist Extensor Wrist Extensor Ext. Carpi Radialis longus and brevis Ext. Carpi Radialis longus and brevis Ext. Carpi Ulnaris Ext. Carpi Ulnaris Ext. Digitorum longus Ext. Digitorum longus

Rehabilitation Objectives Rehabilitation Objectives

RestoreRestore Elbow ROM Elbow ROM MaintainMaintain Shoulder and Wrist ROM Shoulder and Wrist ROM

Rehabilitation ObjectivesRehabilitation Objectives

Elbow and Forearm ROM Elbow and Forearm ROM

Motion Motion Normal Normal FunctionalFunctional Flexion Flexion 150*150* 90*90* Extension Extension -5*-0*-5*-0* lacking 20-lacking 20-

30*30*

Pronation Pronation 90*90* 50*50* Supination Supination 90*90* 50*50*

Considerations Considerations

Check circulation Check circulation Check dermatomes Check dermatomes Skin healing problems due Skin healing problems due

to hardware to hardware