Introduction
The elbow is a common term representing the area connecting the upper arm and the forearm enveloping the elbow joint. The elbow joint is one of the largest joints in the body and comprises the articulation between the long bone of the upper arm (the humerus) and the long bones of the forearm (the radius and the ulna). The elbow joint is a hinge type of joint and is associated with numerous muscles, ligaments, and tendons. The primary function of the elbow joint is to stretch and bend the arms for various activities held through the hand.
What Is Olecranon?
The olecranon is a large, thick, bony curvature present at the upper end of the ulna bone. It forms the pointed end of the elbow in the bent position. The term olecranon is the combination of two Greek words, olene, meaning the elbow, and kranon, meaning the head. Thus, it resembles the dome head of the elbow.
On the front surface, the upper end of the ulna bone has a c-shaped concave curvature called the trochlear notch, which articulates with the trochlear eminence of the humerus bone. This notch's outer and upper borders form the olecranon process that articulates with the olecranon fossa of the humerus bone. These articulations form the glenohumeral joint.
What Is the Inside of the Elbow Called?
The inside of the elbow is called the cubital fossa, which acts as a transition between the forearm and the anatomical arm. This part presents a depression in the elbow joint’s anterior surface. Another name for this part is the antecubital fossa.
What Is an Olecranon Fracture?
The olecranon fracture is a break in the pointed bony projection of the elbow joint. The fractures of the olecranon are relatively more common because of its prominent location, making it vulnerable to direct trauma. The olecranon fracture is very rare in children because the structure is thicker and stronger in early life. This fracture occurs mostly due to direct high-energy blows in young individuals or a simple fall in older people.
What Are the Types of Olecranon Fracture?
Based on the displacement of the olecranon, the number of fractured fragments, and the elbow stability, the fracture of the olecranon process can be divided into three types with two subtypes. This classification is termed the Mayo classification system.
What Are the Signs and Symptoms of Olecranon Fracture?
A sudden and severe pain immediately follows the impact of an olecranon fracture.
Some of the usual other symptoms of the olecranon are:
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Swelling around the elbow region.
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Instability of the elbow joint.
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Tenderness in and around the joint.
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Bleeding or bruising in the injured area.
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Increased pain and discomfort with elbow movement.
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Numbness and tingling sensation in the fourth and fifth fingers.
How to Diagnose Olecranon Fracture?
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Physical Examination:
Physicians will assess the injury site or the fractured elbow to inspect the visible wound and contamination. The elbow's stability and the defect's area can be evaluated by palpating the region. A neurological examination is also done to check for sensory disturbances.
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X-rays:
Side-view X-rays are the preferred line of choice to investigate the olecranon fracture or the fractured elbow. Usually, a normal X-ray will give all the details of an olecranon fracture, like the number of fractured fragments and the degree of displacement. Therefore, the X-rays will determine the mode of treatment.
How to Treat Olecranon Fracture?
For any bone fracture, especially if it is an open type, the initial treatment will be debridement, applying pressure to stop bleeding, medications such as NSAIDs (non-steroidal anti-inflammatory drugs), and ice packs to reduce swelling. Further, depending on the extent and complexity of the fracture, the elbow fracture treatment can be as follows:
1. Non-surgical:
Conservative and non-invasive elbow fracture treatment may be sufficient for fractures with little or no displacement. Typically, the elbow joint is held in a proper anatomic position and splinted for immobilization (to stop the movement of the broken limb). Usually, it is done using a cast (made from plaster or plastic) or a brace (specially designed device to support the broken bones) with a sling support.
2. Surgical:
Surgical treatment may be required in cases of an open and displaced type of olecranon fracture.
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Tension Band Wiring:
The wires engage the fractured bones and are knotted to provide stronger fixation. The theory behind tension band wiring is to counteract the tensile forces and convert them to compressive forces. This technique is commonly used for non-comminuted transverse olecranon fractures.
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Open Reduction and Rigid Fixation:
Open reduction and rigid fixation involve surgically opening the fracture site, and the broken bones are set together nearby and fixed using plates and screws. This method is called internal fixation. It is often considered the best treatment to maintain the ulna's length and alignment.
Sometimes, in addition to the internal fixation, using an external fixation or distraction device can help maintain joint stability. These devices consist of rods, clamps, pins, screws, and threads. The external fixators can be static or dynamic and are mainly used for displaced, unstable, and comminuted fractures of the olecranon process.
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Bone Grafts:
Bone grafting means the replacement of missing bone tissue in the damaged area. Primarily, bone grafting is used at the fractured site to reduce the risk of nonunion, especially in complex fracture conditions like type III B olecranon fracture.
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Elbow Arthroplasty:
Joint replacement surgery is known as arthroplasty. Elbow arthroplasty can be considered in elderly patients with associated bone-weakening diseases.
After surgical treatment, patients must be placed in elbow splints for a few days. Mild exercises must be initiated to reduce joint stiffness and improve the range of motion in the elbow joint.
What Is the Recovery Time for a Broken Elbow?
Recovery of any fracture takes from a few days to a few weeks. Most use ice, affected area elevation, and pain medications. Whether the person has undergone surgical or non-surgical treatment, rehabilitation is very important for a complete recovery from an elbow fracture. The rehabilitation program is very important for recovery from an elbow fracture as it helps to strengthen the muscle, reduces the stiffness of the joint, and enhances the range of motion.
Conclusion:
Olecranon fractures are relatively common injuries that account for approximately ten percent of upper extremity fractures. Patients must be educated regarding the nature of olecranon injury and the treatment outcome. After treating the olecranon fracture, rehabilitation should be aimed at regaining the elbow joint's strength, flexibility, and movements. Patients usually have a good functional outcome with timely management and good post-operative care.
