There are 8-10% of elbow fractures caused by olecranon fractures. They are intraarticular fractures, disrupting the elbow extensor mechanism, which is why most of these fractures require surgery.
Various fixation techniques are available, but none of them is suitable for treating all olecranon fractures, and each of them is associated with varying levels of complications.
Direct falls over the olecranon can result in impaction of the olecranon against the distal humerus, leading to comminuted fracture, or a sudden eccentric contraction of the triceps upon flexing an elbow during a fall can result in a transverse or oblique fracture.
A combination of the two mechanisms, especially in high-energy trauma, can result in the less common transolecranon fracture dislocation. This usually occurs with concomitant lesioning of bone and soft tissue in the elbow.
Despite a good outcomes, there are some common complications associated with olecranon fractures, such as hardware irritation, extension deficit, and wound healing difficulties.
What is an Olecranon Fracture?
A person’s elbow joint is made up of three bones: the humerus (upper arm bone), the ulna (first forearm bone on the pinky side), and the radius (second forearm bone on the thumb side), which are held together by ligaments, muscles, and tendons. As a hinge, it bends and straightens, but it is also crucial for rotation of the forearm, that is, turning our hands up or down (for example, to accept change from the cashier).
Olecranon fractures are breaks in the pointy bone at the end of your arm, called the ulna, which sticks out when you bend your arm. There are two types of elbow fractures: isolated fractures that occur alone, and more complex fractures that occur in conjunction with other injuries to the elbow.
Olecranon fractures can occur as a result of direct or an indirect blows. Most of the time, the latter happens as a result of landing on an outstretched arm.
What does ORIF mean?
The term “open reduction and internal fixation” (ORIF) refers to a surgical technique for treating fractures that cannot be healed non-surgically.
Causes of Olecranon Fractures:
Here are some causes which is caused by olecranon fractures:
- An elbow injury caused by a direct blow or hit
- An outstretched arm can be injured by falling on it
- An accident involving a high-impact object, such as a motor vehicle
- Sports that involve contact, such as football
- Falling from a height
ORIF Surgery
The ORIF procedure is performed by an orthopedic surgeon. This procedure can be used to repair fractures in an arm or leg, including those in the shoulder, elbow, wrist, hip, knee, and ankle.
A fracture procedure might be performed immediately or scheduled in advance depending on your fracture and risk for complications. It may be necessary to fast and stop taking certain medications before undergoing surgery.
There are some test which has to be done before the procedure:
- Physical exam
- Blood test
- X-ray
- CT scan
- MRI scan
You will be able to get a medical examination if you undergo these tests. ORIF consists of two parts. Depending on the fracture, surgery can last several hours. During general anesthesia, you will be under the care of an anesthesiologist.
While the surgery is taking place, you will be put into a deep sleep so that you won’t feel any pain. Depending on your condition, a breathing tube might be placed in your mouth. The first part of the process involves open reduction. It will take the surgeon some time to move the bone back into its normal position after cutting the skin.
The second part of the procedure is internal fixation. As a result of the surgery, the bone will be held together with metal rods, screws, plates, or pins. Fractures can be treated with various types of hardware, depending on their location and type.
In addition to stitches or staples, the surgeon may apply a bandage to close the incision, apply a cast, or place the limb in a splint, depending on the location and type of fracture.
Physiotherapy after ORIF elbow:
In order to reduce pain, swelling, and stiffness after an ORIF of your elbow and to effectively restore some range of movement, it is essential to receive immediate physiotherapy.
Your physiotherapy should continue with Physio.co.uk once you have been discharged from hospital in order to maximize the success of the surgery, to help you regain as much function as possible in your elbow, and to minimize the possibility of further complications.
Risks and side effects from ORIF Surgery:
A large number of side effects and risks are associated with ORIF surgery, just as they are with any surgical procedure.
These include:
- The incision or hardware may have been infected with bacteria
- Blood clot
- Bleeding
- Bone healing that is incomplete or abnormal healing
- Misaligned metal hardware
- Loss or reduction of mobility
- Damage to the muscles or spasms
- During anesthesia, an allergic reaction may occur
- Damage to blood vessels or nerves
- An injury to a tendon or ligament
- Arthritis
- Tendonitis
- The sound of popping and snapping can be heard
- Hardware-induced chronic pain
- As a result of increased pressure in the arm or leg, compartment syndrome occurs
It might be necessary to remove the hardware if it becomes infected. A fracture that does not heal properly may also require a repeat surgery. There are very few cases of these problems. Smokers and those with certain medical conditions are more likely to experience complications:
- Obesity
- Diabetes
- Liver disease
- Rheumatoid arthritis
- History of blood clots
Keep your doctor’s instructions in mind before and after surgery to reduce your chances of complications.
Complications of Olecranon Fractures:
It is possible for patients that have suffered olecranon fractures to have long-term complications even if they have received successful treatment.
Loss of Motion
Patients may not be able to regain full motion in their affected elbow in some cases. A patient with this condition is often not capable of fully extending or straightening their arm.
An arm that loses a few degrees of straightening usually does not lose its overall functionality. Physical therapy, special bracing, or additional surgery may be required if there is significant loss of motion. Fractures of the olecranon are uncommon.
Posttraumatic Arthritis:
The term posttraumatic arthritis refers to arthritis that occurs in a joint following an injury. It is possible to sustain cartilage damage on the joint surfaces even when you heal your bones normally, which results in chronic stiffness and pain.
The occurrence of posttraumatic arthritis after olecranon fractures is relatively common. Depending on the type of fracture, it may occur immediately after the fracture or may take years to develop.
The symptoms of posttraumatic arthritis may require further surgery for some patients. However, for many patients, no further treatment is necessary because the pain is minimal.