1. Olecranon Fractures By: Christine Davis http://www.youtube.com/watch?v=hVc3N QhAw_I&NR=1

2. Common Mechanism  Falling on flexed elbow when triceps are contracted to help break the fall.  Commonly an avulsion fracture  Direct blow to elbow  Elbow hyperextension

3. Classification of Olecranon Fractures  Schatzker Classification Transverse transverse impacted Oblique Comminuted Oblique distal Fracture Dislocation

5. Treatment Goals  Alignment  Articular restoration  Stability  Relationship between humerus and ulna

6. Treatment  Closed Reduction and Splint or Cast  Used for non-displaced, stable fractures.  Elbow should be held in 90 degrees flexion for 4 weeks.

7. Treatment Cont.  Open Reduction and Internal Fixation (ORIF)  Recommended if less than 45 degrees of flexion is required to maintain reduction  Method of choice for displaced and comminuted fractures  Fixation Methods  Large intramedullary screw  Tension band  K-wires  Plate & screw  Combination

9. Day One to Week One  Stability: NONE  ROM:  Surgical: Gentle elbow flexion and AROM in wrist  Cast: No ROM to elbow or wrist  Strength: Isometric wrist strengthening in cast after 3-4 days.  Functional Activities: Only one armed activities with uninjured arm.

10. Week 2  Stability: None to minimal  ROM:  Surgical: Active elbow flexion and AROM in wrist  Cast: No ROM  Strength: No strength to elbow in extension. Isometric to elbow and wrist.  Functional Activities: Only one armed activities with uninjured arm.

11. Four to Six Weeks  Stability: Usually stable with bridging callus  ROM: Active ROM in flexion and extension  Strength: Isometric exercises in flexion and extension  Functional Activities: May use affected arm for stability and light self care.

12. Six to Eight Weeks  Stability: Stable  ROM: Full AROM to AAROM in all planes to elbow and wrist  Strength: Resistive exercise to elbow and wrist  Functional Activities: May use affected arm for everyday activities

13. Eight to Twelve Weeks  Stability: Stable  ROM: Full AROM and AAROM in all planes to elbow and wrist.  Strength: Resistive exercise to elbow and wrist  Functional Activities: May use injured arm for everyday activities

14. Expected Time Lost  Expected time of bone healing:  10-12 weeks  Expected duration of rehab  10-12 weeks

15. Muscle Strengthening  Elbow Muscles  Triceps  Biceps  Pronators  Supinators  Wrist Flexors  Flex. Carpi Radialis  Flex. Carpi Ulnaris  Flex. Digitorum longus and sublimis

16. Muscle Strengthening Cont.  Wrist Extensor  Ext. Carpi Radialis longus and brevis  Ext. Carpi Ulnaris  Ext. Digitorum longus

17. Rehabilitation Objectives  Restore Elbow ROM  Maintain Shoulder and Wrist ROM

18. Rehabilitation Objectives Elbow and Forearm ROM Motion Normal Functional  Flexion 150*90*  Extension -5*-0* lacking 20-30*  Pronation 90*50*  Supination 90*50*

19. Considerations  Check circulation  Check dermatomes  Skin healing problems due to hardware to hardware