Fracture of the olecranon

A fracture of the ulnar process is a violation of the integrity of the ulnar process of the ulna as a result of traumatic impact. It is manifested by swelling, soreness, bruising and restricted movement.

Pathology is diagnosed taking into account complaints, external examination data and the results of X-ray examination.

In doubtful cases, a CT or MRI scan is prescribed.

Treatment of fractures without displacement is conservative. For dislocated fractures, surgery is required - a transosseous suture, fixation of the fragment with a metal structure, or resection of the ulnar process.

A fracture of the ulnar process is a fairly common injury. Such injuries account for about 1% of the total number of fractures of the limb bones and 6-30% of the total number of intra-articular fractures of the elbow joint. They are most often found in young and middle-aged people. Children under the age of 10 are very rare.

In most cases, they are accompanied by displacement of fragments and the formation of diastasis between the ulna and the "detached"fragment of the ulnar process. This is caused by the strength of the triceps brachii muscle.

Injury mechanism:

• direct:< / li>
  < li>falling on the elbow in the position of its flexion< / li> < li>penetrating injuries of the elbow joint< / li>
• indirect:< / li>
  < li>falling on the forearm (the ulnar process is pressed into the distal part of the humerus by excessive extension of the elbow at arm's length) < li>a sharp compression of the triceps tears off the ulnar process< / li> < Li > stress fracture is less common and is observed mainly in throwing athletes (for example, in baseball) with a gradual appearance of pain, which increases with repeated throwing movements.

Classification:
< img width= "468"alt=" perelom-loktevogo-otrostka-1.jpg "src=" /upload/medialibrary/8f3/8f3a61042cc1b6f826626cad440b8c91.jpg "height=" 351 " title="perelom-loktevogo-otrostka-1.jpg depending on the level, fractures of the tip, base and middle of the ulnar process are distinguished, depending on the nature of the damage - simple, oblique, transverse and comminuted injuries.

In some cases, fractures with compression elements may occur, in this case, the area of the spongy bone that makes up the ulnar process is crumpled.

Closed and open damage with or without displacement of fragments is possible.

Most fractures are intra-articular. Select:

< li>type 1 or damage without displacement: type 1A (non-comminuted), type 1B (comminuted);< / li> < li>type 2 or stable offset injuries: type 2a (non-comminuted), type 2b (comminuted). The displacement of the fragment is more than 2-3 mm, while maintaining the stability of the forearm bones relative to the shoulder. Collateral ligaments are not damaged;< / li> < li>type 3 or unstable offset injuries: type 3A (non-comminuted) and type 3B (comminuted). They belong to the category of subluxations or perelomovivih.

In more than 90% of cases, damage to the ulnar process is the result of a direct injury - a fall on the back surface of a bent elbow joint or a direct blow to the ulnar process. Less often occurs with an indirect injury-a fall on the arm with a tense triceps muscle. In the latter case, oblique or transverse injuries are formed with varying degrees of displacement.

Fracture symptoms

Complaints of sharp pain in the ulnar process and holding the half-bent sore arm with a healthy one to avoid accidental painful movements. With partial ruptures of the triceps tendon and dislocated injuries, active extension of the forearm is impossible. The elbow joint swells (mainly on the back surface), hemorrhages are often detected. Palpation is sharply painful, in some cases it is possible to find a gap between the bone fragments.

Diagnostics

To clarify the diagnosis, radiography of the elbow joint is prescribed. Best of all, such fractures are visible in side images when bending the forearm at an angle of 90 degrees. Radiographs usually clearly determine the nature and number of fragments, as well as the amount of diastasis between them.

Additional research is usually not required. In some cases, patients are referred for CT or MRI of the elbow joint to detail dense structures.

Fractures of the ulnar process can be accompanied by damage to the ulnar nerve, so if there are neurological symptoms, you need to consult a neurologist.

Treatment of ulnar process fracture

In case of injuries without displacement and with a displacement not exceeding 2-3 mm, conservative treatment is possible - immobilization with a plaster splint. The arm is bent at an angle of 50-90 degrees, the forearm is brought to a neutral position. In the first days, anti-inflammatory drugs are prescribed. After the edema subsides (after 7-10 days), a control radiography is performed, and in the absence of secondary displacement, conservative treatment continues. Then use a supportive dressing and prescribe physical therapy, gradually increasing the load. Complete consolidation usually occurs within 6-7 weeks.

It is possible to use thermal treatments, magnetic therapy, massage of the forearm and shoulder muscles. At the stage of rehabilitation, mechanotherapy is used.

Damage to the ulnar process with displacement is an indication for surgery. Surgical intervention is performed in a hospital setting. Depending on the location and nature of the fracture, screw osteosynthesis, spoke osteosynthesis in combination with an eight-shaped Weber loop, plate and screw osteosynthesis, or resection of the proximal fragment with anchor refixation of the shoulder triceps tendon can be used.

The latter method is used for injuries in elderly patients, as well as for multi-comminuted fractures and those that have not fused together.

Its advantage is the elimination of the possibility of non - fusion of fragments, the disadvantages are the presence of a small cosmetic defect (the absence of an elbow protrusion under the skin) and a slight decrease in the effectiveness of the elbow joint.

In the presence of a single fragment, different versions of the loop seam are usually used, with comminuted damage - plates with screws. If it is necessary to remove small fragments, osteosynthesis is combined with plastic surgery with a bone autograft or autograft.

After the operation, there are two possible options. 

In osteosynthesis using a metal structure, plaster is not applied, a supportive kerchief bandage is used for 2-3 weeks, and physical therapy begins depending on the doctor's recommendations (depending on the chosen surgical technique).

When resecting the ulnar process, a posterior splint is applied for 3 weeks. Physical therapy begins on day 7-10, removing the bandage during exercise.

Prognosis and Prevention

The prognosis is usually favorable. In the process of rehabilitation, it should be borne in mind that the elbow joint is one of the most "capricious". Even after a short immobilization, it may experience movement restrictions. It is quite difficult to develop, and the full recovery period can take several months.

The guarantee of complete rehabilitation is perseverance and regular physical therapy classes in exact accordance with the recommendations of the doctor and physical therapy instructor.

Primary prevention is to prevent injuries.

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