Bilateral Olecranon Fracture and Radio-Humeral Dislocation
School of Medicine, Egerton University
Correspondence to: Dr. Fred Kalande, P.O. Box 20115, Egerton, Kenya.
Olecranon fractures constitute 10% of traumatic fractures in the upper limb however; bilateral traumatic olecranon fracture is rare. They follow a fall on a flexed elbow or strike on the point of the elbow or in patients with other systemic pathology such as Rheumatoid arthritis or sarcoidosis. Bilateral fractures with posterior radio humeral dislocation are even rarer and offer a management dilemma. We report one case of traumatic bilateral olecranon fractures with posterior radio-humeral dislocation without any concomitant systemic disease. After imaging studies, the olecranon fracture was classified using Mayo classification and the patient was prepared for surgery under general anesthesia. Tension band wiring fixation was performed on the left oblique olecranon fracture and contoured reconstruction
plate fixation was performed on the right comminuted fracture. The recovery was uneventful and through intense physiotherapy the elbow function was quite impressive. The patient was able to perform daily living activities on his own having achieved Mayo elbow score (MES) of 90 on the right and 85 on the left.
Key words: Bilateral Olecranon fracture, Radio-Humeral dislocation, Mayo classification
Ann Afr Surg. 2018;15(2):77-80 DOI:http://dx.doi.org/10.4314/aas.v15i2.10
© 2018 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Conflicts of Interest: None
Trauma to the upper limb is devastating as it affects the livelihood of the patient and injuries around the elbow are associated with posttraumatic loss of joint range of motion. Unilateral olecranon fractures constitute 10% of upper limb fractures (1). They follow trauma either as a fall from a height on the elbow or motor vehicle accident injury as a side swipe. Bilateral fractures of olecranon are very rare. They have been seen in patients with other systematic pathology such as rheumatoid arthritis or sarcoidosis (2, 3). Bilateral traumatic olecranon fractures in healthy individual are quite rare. This paper highlights this rare injury and the challenges in treatment and outcome.
A 30yr old carpenter on outstretched hands fell from a height of about 3 meters while repairing a roof. He sustained injuries to both elbows, and bruises over the trunk; there were no other associated injuries. There was no loss of consciousness during and after the fall. On examination, he had grossly swollen tender elbows with minimal bruising over the posterior surface.
No bleeding or cuts were seen.
Brachial and radial pulses were present on both limbs. Sensation was normal. The elbows were splinted flexed at 900 and intramuscular analgesia administered. A radiograph showed bilateral fractures of the olecranon with posterior radio-humeral dislocation (Figure 1).
Informed consent was obtained from the patient for open reduction and internal fixation to be performed under general anaesthesia. Intraoperatively, prophylaxis antibiotic (2grams cefuroxime) was given, tourniquet was applied and in supine position; bilateral posterior elbow incisions were made to expose the fractures; which were then reduced and prefixed with K wires. The left olecranon fracture was finally fixed by tension band wiring due to its transverse nature while the right was reduced and fixed with a contoured reconstruction plate and screws because it was comminuted.
The dislocations reduced spontaneously after the fracture fixation. The annular ligaments were repaired using absorbable 2/0 polyglactin suture. Stability intra operatively was ascertained by going through a full range of motion without any loss of reduction.
The elbows were then immobilized in back slab at 900 of flexion after the surgery. The post reduction radiographs were satisfactory (Figure 2).