From the Guidelines
For olecranon process fractures, simple immobilization is the most appropriate initial treatment when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle of minimizing disruption to the fracture site while allowing for the natural healing process to occur, as noted in the American College of Foot and Ankle Surgeons' guidelines for diagnosis and treatment of heel pain, although the specific application to olecranon fractures requires consideration of the unique anatomy and function of the elbow 1.
Key Considerations for Immobilization
- The goal of immobilization is to maintain alignment and reduce stress on the fracture site, thereby promoting optimal healing conditions.
- For non-displaced or minimally displaced fractures, immobilization methods that allow for early controlled motion can help prevent joint stiffness and maintain functional range of motion.
- The choice of immobilization technique should balance the need for fracture stability with the risk of prolonged immobilization leading to elbow stiffness and functional limitations.
Immobilization Techniques
- A posterior long arm splint with the elbow flexed at 60-90 degrees can be an effective initial immobilization method for olecranon process fractures, as it maintains alignment and reduces stress on the fracture site.
- For fractures that are non-displaced or minimally displaced, conversion to a hinged elbow brace after 1-2 weeks can facilitate controlled range of motion while protecting the fracture, based on the general principles of fracture management 1.
- Post-operative immobilization for displaced fractures requiring surgical fixation typically involves a posterior splint for 1-2 weeks, followed by progressive mobilization based on the stability of the fracture fixation.
From the Research
Immobilization for Olecranon Process
- The type of immobilization for olecranon process fractures can vary depending on the severity and displacement of the fracture, as well as the patient's overall health and age 2, 3, 4.
- For nondisplaced fractures, a short period of immobilization followed by gradually increasing range of motion may be sufficient 3.
- For displaced fractures, internal fixation is often recommended, with techniques such as tension band wiring, open reduction internal fixation with a pre-contoured locking plate, and tension band suture fixation 2, 3.
- In some cases, particularly for older patients or those with osteoporotic bone, nonoperative management with immobilization in an above elbow cast for 4 weeks may be considered 2, 4.
- A custom-modified corrective elbow flexion splint may be used during rehabilitation for patients with complex forearm deformities or other underlying conditions 5.
Considerations for Immobilization
- The choice of immobilization method should take into account the patient's individual needs and circumstances, including their age, overall health, and the severity of the fracture 2, 3, 4.
- Immobilization should be followed by gradual mobilization and rehabilitation to minimize stiffness and promote optimal functional outcomes 3, 5.