Traumatic Pediatric Olecranon Injury

Abstract

Elbow injuries make up to 3% to 4% of all emergency department presentations and are often difficult to diagnose. These injuries are often missed on radiographs because of the large cartilaginous component of the pediatric elbow resulting in malunion. Fractures around the elbow joint are one of the leading causes of litigation claim, and awareness of the pitfalls in diagnosis of these subtle injuries is necessary for a prompt diagnosis. Fracture of the olecranon epiphysis is rare and often being described around puberty and in association with osteogenesis imperfecta. Management using K-wire tension band fixation has been described in the past, which can lead to growth arrest in younger patients.We hereby present a missed rare sleeve-type open olecranon epiphyseal fracture in a young child, highlighting the pitfalls in the diagnosis of these injuries. This article also reviews various options to manage such a rare fracture and also suggests an alternative method of transosseous suture fixation with an excellent result.

Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system

“…However, Rath et al [37] describe the transosseous suture for the fixation of fragments as an alternative method, which has given excellent results in healthy pediatric patients.…”

Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique

“…In addition, an absorbable suture tension band technique with and without removable percutaneous K-wires has been described in 7 pediatric patients with the aim of avoiding reoperation for hardware removal. 8,17 Although good functional outcomes have been reported with use of suture anchors to surgically repair traumatic ruptures of the distal triceps tendon, there have been few data on the use of suture anchor fixation for olecranon fractures. 2 Ravenscroft et al 18 recently described their experience using tension band technique with metal suture anchors with Orthocord (Fastin RC 5.0 mm; DePuy Mitek, Leeds, UK) for the treatment of 14 Mayo IIA olecranon fractures and 8 olecranon osteotomies.…”

Surgical Treatment of Displaced Olecranon Fracture Through a Persistent Physis: Case Report and Review of the Literature

“…7 Of these, the incidence of an isolated olecranon fracture is 12% to 20%, 7,24 with physeal injury still rarely described in the orthopaedic literature. 6,10,11,17,29,31 The olecranon initially forms as multiple ossification centers which are first radiographically apparent at age 9 to 11 years and fuse by 13 to 17 years. 5,6,10,14,17,28 This process begins on the anterior border of the olecranon and progresses in a proximal-to-distal direction.…”

“…With regard to olecranon anatomy and pattern of injury, there exists some debate as to the exact insertion of the triceps expansion, with some authors describing its location distal to the olecranon physis 28,36,39 and others describing the insertion directly into the olecranon physis. 31,33…”

“…The most commonly cited indication for operative intervention is the degree of fracture displacement, but this varies between studies from displacements greater than 2 to 5 mm on initial radiographs. 3,10,14,18,21,27,31,34 Still others advocate for surgery when there is any incongruence of the articular surface 31 or if palpation of the olecranon defect during elbow ROM demonstrates any instability. 39…”