What's the Diagnosis? By Dr. Loran Hatch

A 60 yo F presents to the ED after a fall from height with pain in her L upper extremity. On exam, she is holding her L elbow in flexion. She has posterior elbow tenderness and swelling w/ decreased ROM, but is neurovascularly intact. A L elbow xray is obtained and shown below. What's the diagnosis?  (scroll down for answer)



Answer: L olecranon fracture

  • Represents ~10% of all upper extremity fractures
  • Mechanism: direct force or fall with hyperextension/FOOSH
  • Exam: localized tenderness/swelling of posterior elbow
  • Mayo classification:
    • Type 1: nondisplaced
    • Type 2: displaced
    • Type 3: unstable w associated injury +/- comminuted
  • Treatment: immobilization w/ long arm posterior split w/ elbow in flexion
  • Typically needs surgical repair
  • Complications: decreased ROM (loss of extension), impaired tricep function, ulnar neuritis, heterotopic ossification, post-traumatic arthritis



Baecher N and Edwards S. Olecranon Fractures. Journal of Hand surgery. 2013; 38(3): 593-604

Chow, Yvonne C.. "Elbow and Forearm Injuries." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016