olecranon fracture
Introduction
Introduction to the olecranon fracture Ulnar olecranon fracture is a common injury to the elbow, which is more common in adults. Except for a few avulsion fractures of the olecranon tip, most cases have fracture lines and intra-articular fractures of the semilunar articular surface. Due to the contraction of the elbow joint and flexor, the fracture is prone to separation and displacement. Therefore, during treatment Recovering the normal anatomical alignment of the articular surface and firmly fixing the early active joint is an important measure to obtain good function. If the joint faces are not uniform, it may cause traumatic arthritis, resulting in joint pain and limited function. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: Traumatic arthritis
Cause
Etiology of olecranon fracture
Mechanical factor (90%)
When the elbow joint is in the straight position, the external force is transmitted to the elbow, and the triceps muscle is pulled to cause avulsion fracture. The fracture line may be transverse or oblique, and the two fracture ends are separated. Directly hit the elbow, causing comminuted fractures.
There is no consensus on the classification of fractures. Some scholars have divided the fractures into the following categories.
1. Non-displaced fracture: There is no displacement of the fracture, which may include comminution, transverse or oblique fracture. The X-ray film shows that the fracture is separated by 2 mm or less. The elbow joint has anti-gravity activity, that is, the complete elbow function.
2, there are displaced fractures: the fracture end is separated above 3mm, and there is no elbow movement against gravity, and is divided into the following.
(1) Avulsion fractures: more often occur at the triceps callus, the fracture block is smaller, and the fracture line is mostly horizontal.
(2) transverse fracture or oblique fracture: the fracture line of the oblique fracture is mostly from the front to the back, which is conducive to fixing with screws.
(3) comminuted fractures: mostly caused by direct external force, sometimes combined with soft tissue open injury.
(4) Fractures with dislocation of the elbow joint: more common in the anterior dislocation of the elbow joint, the transverse line or short oblique line of the fracture line, and more often occurred in the level of the ulnar coronoid process with obvious displacement.
Pathogenesis
Ulnar olecranon fractures can occur in patients of different ages, but more common in young adults, the injury mechanism can be direct violence, the patient falls to the back of the elbow, or the blunt directly hits the back of the elbow; indirect violence, triceps triceps Contraction, or the palm of the hand, the upward impact of the impact on the ulnar half-moon notch causes the olecranon fracture, the fracture caused by direct violence is mostly comminuted, and the fracture fracture line caused by indirect violence can be horizontal, oblique, or crushed. Sexual, ulnar olecranon fracture end displacement, the degree of separation and the size of the triceps contraction force at the time of fracture, the degree of tear of the deep fascia tissue around the olecranon, as well as the direction of violence, the size is closely related to direct violence The comminuted fracture, the soft tissue damage around the olecranon is light, and the direction of violence is toward the front of the elbow, so the displacement of the fracture block is not obvious.
Prevention
Ulnar olecranon fracture prevention
prevention:
The disease is caused by trauma, in addition to paying attention to production and life safety, avoiding trauma without effective preventive measures.
Prognosis:
The olecranon is mainly composed of cancellous bone. After a good reduction and stable fixation of the olecranon fracture, the fracture ends are in close contact, the healing is rapid, the prognosis is good, but the articular surface damage is more than 60% or postoperative. If the articular surface is still displaced more than 2 mm, the prognosis is poor.
Complication
Ulnar olecranon fracture complications Complications, traumatic arthritis
Patients with this disease can have some of the following complications:
1, fracture nonunion is less common, the incidence rate does not exceed 5%, often due to the existence of gaps in the fracture end, causing fiber healing, such as small gaps, there are strong thick fibers in between;
2, elbow joint dysfunction is less common, if the gap is large, there is a slender fibrous tissue that is easily stretched, which is easy to cause the elbow joint to straighten, or even lighter violence can lead to fiber healing. When the fracture occurs, the separation of the fracture ends causes the fibers to heal, shortening the distance between the starting and ending points of the triceps, and weakening the elbow joint.
Surgical treatment should be performed when the fracture is not healed with pain or the flexion and extension of the elbow is more severe. For young patients, internal fixation and bone grafting should be used. During the operation, the hardened surface of the fracture end should be removed, and then according to the specific conditions. It is necessary to fill the defect with the bone graft, and to fix the tension band or the steel plate. Regardless of the fixing method, when the axial compression is performed during the operation, care should be taken to prevent the distance between the coronoid process and the olecranon from shortening.
3. According to Eriksson et al. (1957), up to 50% of patients have limited mobility, especially elbow extension, but it is rare in the cases he reports, only 3%, activity is often limited. Severe, has little effect on daily functions, and often does not cause the patient's attention. It may be related to improper functional exercise and the withdrawal of the needle of the fixed needle to stimulate the dorsal aspect of the distal end of the humerus. Generally, no special treatment is required, and 10 fractures are not good, often concurrent In traumatic arthritis, % of patients may have ulnar nerve symptoms, including numbness, decreased sensation, etc., but most of them can recover on their own without special treatment.
4, the fracture is not good, often complicated by traumatic arthritis.
Symptom
Ulnar olecranon fracture symptoms common symptoms oblique fracture forearm supination function limitation joint pain forearm rotation pain comminuted fracture elbow joint can not flex avulsion fracture
Because the olecranon fracture is an intra-articular fracture, all olecranon fractures contain some degree of intra-articular part, so intra-articular hemorrhage and exudation often occur, which will cause swelling and pain near the olecranon. Touching the depression, accompanied by pain and limited mobility, the elbow joint can not resist gravity and elbow is one of the most important signs, it shows that the triceps function of the triceps is lost, the continuity of the extensor device is interrupted, and the appearance of this sign Or not, often decide how to determine the treatment plan, because the olecranon fracture sometimes combined with ulnar nerve injury, especially when direct violence leads to severely comminuted fracture, it is more likely to have ulnar nerve injury, so it should be carefully judged before determining the treatment plan or Assess the function of the nervous system for timely processing.
After ulnar olecranon fracture, local swelling is obvious, subcortical bone may also be accompanied by subcutaneous congestion, tenderness is more severe, sometimes may touch fractures or bone rubbing, elbow joints are semi-flexible, flexion and extension dysfunction.
In the adolescents, the osteophytes are often separated. According to the shape of the fracture, the olecranon fracture can be divided into two categories: no displacement and displacement.
1. Non-displaced fracture refers to the separation of the fracture end is less than 2mm, the extension elbow device is still intact, and has the ability to resist active elbow movement.
2. Displacement fractures are separated by more than 3mm at the fracture end, because the periosteum and triceps tendon are also broken, and can not resist gravitation and elbow.
1 avulsion fracture, mostly at the triceps tendon stop point, the fracture line does not enter the joint cavity;
2 transverse or oblique fractures, the fracture line is mostly from the front to the back, this fracture is conducive to screw fixation;
3 comminuted fractures, mostly direct external force injury, half-monthly incision cartilage surface can collapse;
4 fracture of the ulna olecranon with elbow dislocation, the fracture line is mostly at the level of the ulnar coronoid process, accompanied by the proximal dislocation of the proximal radius of the ulna.
1. X-ray elbow joint lateral image: because of the displacement of the fracture, it is often not shown on the positive image.
2. Bilateral X-ray film comparison: The elbow joint bone center may be confused with the fracture before fusion, and the suspicious person should take a healthy side contrast.
Examine
Ulnar olecranon fracture examination
No relevant laboratory tests, the auxiliary examination of this disease is mainly X-ray examination:
One of the most common errors in assessing olecranon fractures is that a true elbow lateral radiograph cannot be obtained. In the emergency room, a laterally inclined X-ray is often obtained, which is not sufficient. To determine the exact length of the fracture line, the degree of fracture comminution, the extent of the articular surface tear at the half-moon incision, and any displacement of the humeral head, a true X-ray of the elbow joint should be obtained as much as possible to accurately grasp the fracture. Characteristics, anterior and posterior X-ray plain film is also very important, it can show the direction of the fracture line in the sagittal plane. If the humeral head also has a fracture at the same time, the lateral X-ray film can be obviously broken along the fracture line, and No angle or shift, if necessary, take a double-sided X-ray film control.
Diagnosis
Diagnosis and diagnosis of olecranon fracture
After a dislocation fracture, swelling, tenderness, displaced fractures and fractures with dislocation, the swelling range is wider, the depression can be touched behind the elbow, the fracture block and bone squeak, the elbow joint function is lost, and most of the diagnosis is easy. Suspicious persons should take the following measures.
X-ray lateral slices are easier to determine the fracture. The fracture should be differentiated from the sesamoid in the tendon of the ulnar olecranon and the osteophytes that have not yet closed. When it is difficult to identify, the bilateral X-ray films should be taken.
