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Clinical Practice Guidelines

Olecranon fracture - Fracture clinics

  • Fracture Guideline Index

    See also:  Olecranon fracture - Emergency Department  

    1. How often should these fractures be followed up in fracture clinics? 
    2. What should I review at each appointment? 
    3. What are the potential complications associated with this injury?
    4. When should I refer for an orthopaedic consultant opinion? 
    5. What are the indications for discharge? 

    1. How often should these fractures be followed up in fracture clinics?

    Table 1: Recommended follow-up schedule for olecranon fractures.

    Fracture type

    First appointment

    Subsequent review appointments

    Discharge advice to parents

    Isolated, undisplaced/stable

    Within 1 week post- injury (with x-ray)

    At 3 weeks post-injury (cast removal with x-ray and mobilise)

    At 3 months post-injury (with x-ray and final clinical check)

    See GP if any subsequent deterioration in elbow function/development of symptoms

    Isolated, displaced/unstable (treated operatively)

    At 1 week post-operative with x-ray

    May need readmission for removal of metalwork (typically wires) depending on treatment received

    At 3 weeks post-operative (cast removal with x-ray and mobilise)

    At 6 weeks post-operative for clinical check with x-ray

    At 3 months post-operative (to check range of movement (ROM)

    At 1 year post-operative (with x-ray and final clinical check)

    As above

    Combined injuries

    At 1 week post-operative with x-ray

    May need readmission for removal of metalwork (typically wires) depending on treatment received

    At 3 weeks post-operative (cast removal with x-ray and mobilise)

    At 6 weeks post-operative for clinical check with x-ray

    At 3 months post-operative (to check range of movement (ROM)

    At 1 year post-operative (with x-ray and final clinical check)

    Consider further review if concerns about growth

    As above


    2.     What should I review at each appointment?

    ! 

    Always look for any evidence of a 'missed' injury, especially dislocation of the radial head. 

     

    Early: Maintenance of reduction/fixation (x-ray).

    Intermediate: Progress with mobilisation (when allowed).

    Late: Evidence for disturbed growth (proximal radius if injured).

    Always look for any evidence of a 'missed' injury.

    3. What are the potential complications associated with this injury?

    Poorer outcome than anticipated by doctor/parents.

    Stiffness (failure to regain full elbow ROM).

    Proximal radiohumeral dysfunction in combined injuries.

    Ulnar nerve injury.

    4. When should I refer for an orthopaedic consultant opinion?

    Monteggia variant injuries should be treated by a consultant.

    5. What are the indications for discharge?

    Healed fracture, normal/near normal ROM and no ongoing concerns.

    References (Outpatient setting)

    Green NE, Van Zeeland NL. Fractures and dislocations about the elbow. In Green N, Swiontkowski M. Skeletal Trauma in Children, 4th Ed. Saunders Elsevier, Philadelphia 2009. p.207-82

    Feedback

    Content developed by Victorian Paediatric Orthopaedic Network. 
    To provide feedback, please email rch.orthopaedics@rch.org.au