Olecranon Fractures- Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes olecranon fracture, and provides a simple and easy to understand review about it, the signs and symptoms, diagnostic tests, and treatment options.
Fractures of the olecranon can occur from a direct blow to the elbow or from a fall on an outstretched hand.
There is several classification systems, the classifications I use is the Colton classification:
• Nondisplaced fracture:
- Stable.
- The fracture has less than 2mm of separation
- That separation will not increase with elbow flexion
- The extensor mechanism is intact and the patient will be able to extend the elbow against gravity.
• Displaced fracture:
- Avulsion fracture
- Oblique or Transverse fracture
- Comminuted fracture
- Fracture dislocation
The olecranon fracture dislocation can be several types:
Anterior trans-olecranon fracture dislocation
Posterior Montiggia fracture dislocation.
Examination of the patient will show the patient is unable to extend the elbow with these displaced fractures.
A true lateral view in the x-ray will clearly show the olecranon fracture.
Usually this fracture is followed by stiffness of the elbow, in about 50% of the patients.
But it really doesn’t affect the function.
So when you talk about treatment of the olecranon fracture, the goal should be: restorations of the articular surface, preservation of the continuity of extensor mechanism, maintain the elbow stability, and it would be nice to avoid stiffness of the elbow.
Non-operative treatment is used for non-displaced fractures, and it could be used for some displaced fractures in the elderly patients, you treat the elbow with some flexion with a splint, I would personally use a minimally invasive technique in these patients unless the skin is very bad or the fracture is comminuted.
Surgery treatment: you want to know about 3 techniques:
1- Tension band technique: will be used for transverse fractures with no comminution, you can use the screws or the k wire, when doing this technique; you want to engage the anterior cortex of the ulna.
You want to avoid over-penetration, to avoid affecting the forearm rotation or injuring the anterior interosseous nerve.
Make sure at the end of the operation you can do pronation and supination otherwise pull them out a little bit.
This tension band mechanism takes the distractive force of the triceps and converts it to compression force at the articular surface, especially when the patient bends the elbow.
There are some technical points in this operation; one of them is the drill for the wire should be 4-5 cm from the fracture which gives enough safe distance so that the fracture will not propagate.
The second one: put the wire through the drilled holes, before application of the k wire.
Make sure that the hook of the k wire is posterior; the tension band wire is close to the bone so that there is no laxity in the fixation and instability.
Never use the cancellous screws by itself.
2- Detach Olecranon and Reattach Triceps: excision of the fracture fragment and triceps advancement is used, if the fracture is less than 50% of the joint space, to treat elderly patients, especially if the fracture is comminuted, for some nonunions when the fracture is small and it can’t be fixed.
Make sure this procedure is done when the elbow is stable, if the elbow has ligamentous instability and you excise the piece of olecranon, and then you are going to make the elbow very unstable.
And when you attach the triceps, attach it closer to the articular surface.
3- Plate and Screw fixation: we use it for everything else, such as:
- Comminuted fractures
- Monteggia fracture
- Oblique fractures extending to the coracoid
- Fracture dislocation
The plate is placed on the tension side of the olecranon (dorsal side).
Sometimes you make an opening in the triceps and place the plate against the bone then suture the triceps on top of the plate so that will avoid hardware prominence.
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[@saleemkhankhetrandr3566]

thank YOU very much

[@nomuvi]

Helo it's a good video. What if I have a neglected transverse fracture of about 4weeks old, will that affect my elbow flexion in the future

[@mindhacker4152]

Hi sir,
Nail will be removed or stay inside the arm?
Regards
Muhammad Ahsan Mughal

[@danielbohn]

Very helpful! Thank you so much, Dr. Ebraheim 🙏 Greetings from Brazil 🇧🇷

[@aisworjyanarayandas9283]

Sir, i suffering that type of dislocation..and surgery was done fixing k- wire and two screw But k-wire remove. i can not straight my left hand ? Any suggestions please.......

[@kandarptrivedi2285]

Conceptual video for surgery discrimination .. what approach should be used and why ... Your logical reasoning clears all doughts ..

[@funnymoments7225]

1:52 it's same like me , my elbow broke 5 years ago , without treatment ,
I was escaping civil war in somalia ,
I went to doctor 5 months ago , he said we can not do anything your hand ,
My fingers can not fold even ,
What can i do .
Is there any other possible ways to get my hand back

[@NAYouTuCA]

hi Ibrahim immediately after your fracture were you able to use your elbow/hand normally ?

[@sarant1satt683]

I don't think the fact that you can't open your fingers is the fault of the fracture i think is the tendon. Btw how u now

[@sarant1satt683]

Hello,Im 20 years old, when i was younger i was skating for 3 years and i had so many direct hits and blows right in the elbow and especially in the olecranon.Somtimes i was feeling like I had broke it.When i stop skateboarding i didn't have any pain but 2 years later(now)my olecranon started to hurt so much. It is Very very sensitive even with the touch.I mean i can't even rest my hand in the table.i have this pain for 9moths now.The MRI say's that i have edema(post traumatic origin) in the olecranon and high intensity signals with T2 sequences with fat suppression.Maybe i have bone morrow edema.what surgical options i have to relieve from this sensitive olecranon and avoid as much as possible post-traumatic arthritis? can somehow a bone graft help? Thanks

[@ginasofia8908]

I cannot thank you enough for all of your wonderful videos. God bless you. You are helping me earn my DPT. Thank you Jesus for Dr. Ebraheim!!

[@Agnusdei515]

💓💙🙏🙏

[@boopmybutthole3616]

I don't know why....but the color changing running skeleton is pretty damn awsome. Thanks for the video.

[@LinkIsOurChampion]

I fell the day before yesterday and got hit in my elbow on a staircase, I still hope the pain goes, and that’s not a fracture. I don’t wanna go to a hospital with this covid thing!! Since I can flex/extend and move my arm I am gonna give it one or two days more and if it still hurt, whatever, I am going to have taken an X-ray 😫

[@nandorochausa8947]

Hi, I did the same but unfortunately I have small fracture,dr says to rest but it’s a
bout 2 months and still the same pain 😭
What about you?

[@tanzil88]

thank you for making these videos!

[@mihaelasarbu7559]

In 2018 noiembrie am trecut prin asa o operatie plus fractura de col humeral.Sunt bine .Multumesc dl.dr.Fleaca Radu Sorin de la spitalul din Sibiu .Este un excelent ortoped .Timp de 10 ani m.a "reparat" tot mereu din cauza mai multor fracturi .La.mana si picior .O sa.i multumesc toata viata pt.ajutorul primit .Este un OM .

[@leshamcqueen9063]

I fell and hit my elbow and the tip really burns

[@ToTheMoon-jq1nm]

What is recovery time after surgery I think will be trearment 2

[@prakashlucky4563]

Sir same problem sir I want your solution

[@kandarptrivedi2285]

Very good description ...thanks sir

[@Honestmoviereview143]

perfect explained sir thank you 🙏

[@AshishSharma-nw7tq]

Thank you sir video is very helpful... 😇

[@g.annasmith9834]

Brilliant explanation ! Many thanks indeed.

[@dipimage1935]

Thank you. Just broke my elbow. Cominuted fracture, 3 pieces, and I wanted to know what kind of procedure i had been through. And also why can't I fully extend the arm. 3 weeks have passed and it's healing great

[@SanaDaden8]

Amazing explanation, thank you Professor, you made our MedLife easy.

[@ayaabdelrazek8838]

Thanks very much doctor

[@tonytozi1]

Your an educational genious, Nabil

[@NomaanSyed]

Thank you so much Sir!

[@happilystoned]

I gotta get the third one plate waiting for surgery now :( black ice slipped over landed on my elbow

[@happilystoned]

Hi surgery went well i felt a bit of scratch in my hand a bit painful/uncomfortable didn't last long, Then next thing i know i am waking up in recovery i have limited movement in my elbow my cast is off now and i am waiting to do my first physiotherapy appointment as my surgeon said not to do it before 6-8 weeks as you could do more damage than good.

[@lorenzogiovacchini8781]

I suffered a comminuted fracture of my left Olecranon fighting a large fire in San Francisco. My elbow was crushed when I was thrown down handling a large hose line with too much pressure. I had seven surgeries in eleven months and had radiation to stop the heterotypic bone growth. I'm 74 now and will have ulnar nerve transposition surgery in April to relieve pain and numbness in my left hand.

[@Reneebenson]

Not sure if I have a fracture but I have tennis elbow they have tried a shot and pt it acted like it would get better then the pain flared up horrabile and hasnt let up yet

[@hishammohamed8615]

Thank you.

[@Amemon0712]

Very helpful.. thank u

[@حموديالركابي-ظ7ك]

شكراً جزيلاً

[@RohitPrasadaka_rhean]

superb video sir

[@jdalessandro]

Excelente video

[@siddeadly]

I've just learned that i have a fracture in my arm thanks to this video, I cannot extend my elbow at all

[@mohamadsalaheldin6046]

Thanks

[@merblue4776]

It helps me alot thanks doctor 👏🏻😊