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Fracture of the ulna: causes, symptoms, diagnosis, treatment
Last reviewed: 05.07.2025
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What causes an olecranon fracture?
A fracture of the olecranon process most often occurs as a result of a direct mechanism of injury (for example, a fall on the elbow), but can also occur with indirect violence - an avulsion fracture from a sharp contraction of the triceps muscle or from a fall on the hand with the arm extended at the elbow joint.
Symptoms of an olecranon fracture
The patient complains of pain and dysfunction of the joint.
Diagnosis of olecranon fracture
Anamnesis
Inspection and physical examination
The contours of the joint are smoothed due to edema and hemarthrosis. Palpation reveals sharp pain in the fracture zone; in the case of fragment displacement, a slit-like depression is detected, running transversely to the long axis of the bone. The triangle and the line of Poter are damaged. Movements in the elbow joint are limited due to pain. In fractures with displacement, active extension is predominantly affected, since the triceps brachii muscle is involved.
Laboratory and instrumental studies
The diagnosis is confirmed by X-rays in two projections, with the lateral one performed with the elbow joint bent.
Treatment of olecranon fracture
Indications for hospitalization
In outpatient and home settings, fractures of the olecranon process are treated without displacement of fragments.
Conservative treatment of olecranon fracture
In case of fracture of the olecranon without displacement of fragments, 10 ml of 1-2% procaine solution is injected into the fracture site. The elbow joint is bent at an angle of 90-100°, the forearm is set in a position between supination and pronation, the hand is in a functionally advantageous position. The achieved position is fixed with a plaster splint from the upper third of the shoulder to the metacarpophalangeal joints for a period of 3 weeks. Then they begin restorative treatment, and the plaster splint is transferred to a removable one for another 1-2 weeks.
Patients with comminuted fractures and fractures with divergence of fragments are subject to hospitalization.
In case of comminuted fractures and fractures with divergence of fragments, the surgeon's tactics are as follows. Under local anesthesia, closed manual reposition is performed in the extended position of the elbow joint in order to relax the muscles. If the reposition is successful, the limb can be immobilized in a functionally disadvantageous position (extended) with a posterior plaster splint for 4-5 weeks. Then they begin restorative treatment, and the immobilization is transferred to a removable one for another 1-2 weeks.
Surgical treatment of olecranon fracture
A non-aligned fracture of the olecranon disrupts congruence and leads to severe limitation of the elbow joint functions, so open repositioning is necessary. If the fragment distasis of 0.5 cm or more remains, surgical treatment is also indicated. The olecranon fragment is fixed to the bed with a suture (silk, wire) or a long screw, which must pierce the cortical layer of the anterior surface of the ulna. It is even better if it is additionally fixed with a wire loop passed transversely through the ulna, similar to the wire loop in the Weber operation. In recent years, we have been making loops from a slowly absorbable, durable suture material, which eliminates the need for repeated interventions.
Osteosynthesis of the olecranon is also possible with plates. Osteosynthesis should be stable, not require external immobilization and provide the ability to move the elbow joint immediately after surgery.
In case of comminuted fractures, all bone fragments are removed and the triceps tendon is fixed to the ulna.
The limb is immobilized with a plaster cast in a position of flexion at the elbow joint at an angle of 90-100° for 4 weeks permanently and a removable cast is retained for 1-2 weeks. Labor is possible after 8-10 weeks. The metal fixator is removed 12 weeks after the intervention after fusion is confirmed by radiography.
Approximate period of incapacity
Working capacity is restored after 6-8 weeks. In other cases, work is permitted after 8-10 weeks.
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