Olecranon Fractures Trauma Case for FRCS (Tr & Orth) Oral Examination
This is the radiograph of the elbow of a 40-year-old man who fell off his bicycle.
1. What does the radiograph show and how would you manage this patient?
This is an AP and lateral radiograph of the right elbow that shows a comminuted and displaced fracture of the olecranon. After obtaining a full history and examining the patient for any open wounds, significant soft tissue injury, or neurovascular deficit, I would ensure the patient has adequate analgesia and immobilize the limb with an above elbow backslab. My recommendation would be to treat this injury definitively with surgery, and my preference would be to use plate fixation.
This radiograph shows a comminuted and displaced fracture of the olecranon. To manage the patient, a full history should be obtained along with a thorough examination to identify any open wounds, significant soft tissue injury, or neurovascular deficit. Adequate analgesia should be provided, and the limb should be immobilized with an above elbow backslab. Definitive treatment with surgery would be recommended, and my preference would be to use plate fixation.
2. How would you choose between tension band wire fixation and plate fixation for an olecranon fracture?
My preference would be to use tension band wire fixation for simple pattern fractures at the level of the trochlear notch and proximal fractures. For more complex fracture patterns, fracture dislocations, injuries where the joint is subluxed, or for comminuted fractures, plate fixation would be my preferred choice.
Tension band wire fixation is generally preferred for simple pattern fractures at the level of the trochlear notch and proximally, while plate fixation is preferred for more complex fracture patterns, fracture dislocations, injuries where the joint is subluxed, or for comminuted fractures.
3. Can you explain the principle that tension band fixation is based on?
A dorsally applied tension band converts the normally distractive (tensile) force of the triceps into a compressive force at the fracture site. The principle relies on bony contact at the volar cortex and is not recommended for fractures with significant comminution, which are better treated with plating.
Tension band fixation is based on the principle that a dorsally applied tension band converts the normally distractive (tensile) force of the triceps into a compressive force at the fracture site. The bony contact at the volar cortex is important for success in this procedure. However, it should be noted that tension band fixation is not recommended for fractures with significant comminution, which are better treated with plating.
4. Would you consider an alternative treatment for a frail 90-year-old woman with low-functional demands and significant co-morbidities and anaesthetic risks?
Yes, there is emerging evidence that non-operative treatment produces satisfactory functional outcomes for elderly patients with low functional demands even with displaced fractures of the olecranon. Patients would be treated with pain relief, a short period of splintage, and early mobilisation.
Yes, for a frail 90-year-old woman with low-functional demands and significant co-morbidities and anaesthetic risks, it is possible to consider alternative treatment options. There is emerging evidence to suggest that non-operative treatment can produce satisfactory functional outcomes for elderly patients with low functional demands, even with displaced fractures of the olecranon. This treatment would involve pain relief, a short period of splintage, and early mobilisation.
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