Bilateral Synchronous Olecranon Apophyseal Fracture in a Teenager: A Case Report

Abstract

Introduction: While elbow fractures are frequently observed in children, isolated apophyseal detachments of the olecranon are rare, accounting for just 1.7% of all elbow fractures in healthy children. These fractures have been found to have a large positive likelihood ratio for osteogenesis imperfecta (OI). Within the population of patients with OI, the incidence is 13.5%, with 6% sustaining bilateral fractures. There are, however, very few reports of synchronous bilateral fractures. Case Report: A 15-year-old boy sustained a bilateral olecranon apophyse fracture, AO/OTA 21u-M/7 (displaced on the right side and minimal displacement on the left) after a low-energy fall. The patient was submitted on the same day to surgical treatment (open reduction and internal fixation with AO tension band wiring technique) on the right elbow and nonoperative treatment with a cast on the left side. Exome sequencing excluded mutations related to OI. Conclusion: Apophyseal avulsion fractures of the olecranon may not be pathognomonic of OI, However, orthopedists should exercise caution and remain alert to the potential occurrence in patients who experience displaced, isolated olecranon fractures due to low-energy mechanisms, particularly if they have a history of previous fractures. The clinical genetic evaluation was recommended because of clinical suspicion of OI and because patient management can be significantly influenced by genetic testing, particularly when a genetic syndrome is identified. Keywords: Olecranon apophyseal fracture, osteogenesis imperfecta, bilateral synchronous fracture.