Olecranon fractures involve the proximal ulna at the “pointy” tip of the elbow.
They often result from a direct blow or fall on an outstretched hand (FOOSH).
They are intra-articular and can significantly impair extension if not managed properly.

🩺 Clinical Features

Visible swelling and deformity over posterior elbow.
Palpable bony gap at the olecranon process.
Loss of triceps function: inability to extend the elbow.
Check and document neurological status (median, radial, ulnar nerves).
Check and document vascular status (radial & ulnar pulses).

🩻 X-Ray Findings

AP & Lateral Views: Displacement best seen on lateral film.
Look for associated radial head or distal humerus fractures.
Effusion or fat pad sign may indicate occult fracture.

⚡ Management

Pain relief: IV paracetamol ± opioids.
Immobilisation: Long-arm backslab at 90° with broad-arm sling.
Refer to orthopaedics: Most displaced fractures need fixation.

🔧 Surgical Options

Tension Band Wiring (TBW): Standard for simple displaced fractures.
Plate Fixation: Used for comminuted or unstable fractures.
Non-operative: Only for undisplaced or frail, low-demand patients.

⚠️ Key Considerations

Complications: stiffness, loss of extension, non-union, post-traumatic arthritis.
Document neurovascular status before and after any intervention.
Early physio is crucial post-fixation to restore motion.

📊 Comparison of Common Elbow Injuries

Feature	Olecranon Fracture	Supracondylar Fracture	Elbow Dislocation
Typical Mechanism	FOOSH, direct blow to elbow	FOOSH in children	FOOSH, high-energy trauma
Age Group	Adults > Children	Children (esp. 5–10 yrs)	Young adults, sports injuries
Clinical Features	Gap at olecranon, loss of extension	Pain, swelling, reduced flexion, “S-shaped” deformity	Obvious deformity, swelling, inability to move elbow
Neurovascular Risk	Median/ulnar/radial nerves (rare)	Brachial artery injury → risk of Volkmann’s contracture	Median & ulnar nerves; brachial artery
X-ray Findings	Olecranon gap on lateral film	Abnormal anterior humeral line on lateral	Posterior dislocation of ulna & radius
Management	Analgesia → backslab → ortho fixation (TBW/plate)	Analgesia → backslab → ortho (may need K-wire fixation)	Analgesia → reduction under sedation → backslab → ortho

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Olecranon Fracture

🦴 Introduction