upper limbs-3

Olecranon fractures :-
The olecranon process is commonly fractured in falls on the elbow.
The triceps inserts onto the olecranon and this commonly results in distraction of the fracture.
Non-operative treatment is, therefore, seldom feasible.
Internal fixation using a tension-band wire system is the most common method of operative treatment.
Post-operatively a short period of immobilization is usual for 10-14 days after which cautious mobilization of the elbow out of a cast may begin.
The main complication is failure of fixation with delayed or non-union of the fracture.
In children the injury can be treated conservatively if the articular surface has not been disrupted or surgically if there is loss of continuity of the joint surface.

Radial head and neck injuries

It is a common fracture in adult but rarely seen in children.

Mechanism: Fractures of the radial head and neck are quite frequent and result as a consequence of a fall on the outstretched hand.
Force transmitted up the radial shaft results in a compressive axial force on the radius with a fracture of the head itself, or the neck.

Cl/F: localised tenderness at the radial head, painful rotation of the forearm.

X-Ray: one or more fragments of radial head seen in the film none displaced or with some degree of displacement.
The wrist must be x-rayed also for any associated injury.

Radial neck fractures are often minimally displaced and if the angle subtended by the radial articular surface is less than 30° no specific treatment is needed.

Fractures with tilt of the head in excess of 30° usually need to be manipulated or have open reduction and fixation.
Complete dislocation of the radial head may require radial head replacement.


In children an angulation of up to 20° can be accepted, but a greater tilt is an indication for closed reduction, which can be achieved by manipulation or by using a percutaneous wire to reduce the fracture.
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