Imaging Olecranon Fractures |

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Introduction
Olecranon fractures occur in the adult and paediatric population. This page considers imaging techniques and image interpretation related to olecranon fractures


Case 1

This 50 year old lady presented to the Emergency Department after falling onto her right arm. Her right elbow was painful and swollen. She was referred for right elbow radiography.
ap elbowThis is an AP view image of the right elbow. There is a fracture of the right olecranon/ulna (black arrow). The corticated bony fragment adjacent to the medial condyle is likely to be an unfused ossification centre.

The nature of the medial condyle appearance (horizontal white arrow) is uncertain- a fracture cannot be excluded
lateral elbowThis is a malpositioned lateral elbow image. The olecranon/ulna fracture is clearly demonstrated. In addition, there is evidence of a radial head/neck fracture (small white arrow)
Comment
This fracture is typical of a fracture caused by a direct blow to the dorsal aspect of the forearm- usually from a fall. It is good radiographic practice to ensure that there are no other associated fractures- additional views should be performed if there is evidence of associated fractures which are not clearly demonstrated.

Case 2
This 96 year old lady presented to the Emergency Department after falling directly onto her left elbow. She was in considerable pain and showed left elbow swelling. She was referred for radiography of her left elbow.
AP elbowThe AP elbow view image suggests a possible olecranon fracture.
lateral elbowThe lateral view image confirms the olecranon fracture.
axial elbowThe radiographer thought that an axial view of the elbow would provide additional information regarding the nature of the fracture and the degree of comminution. The axial view has been executed to good effect demonstrating the fracture effectively.
Comment
This case demonstrates teh potential value of the axial view of the elbow in cases of olecranon fracture.


Case 3

This 51 year old man presented to the Emergency Department after falling onto both hands. He was examined and found to have a painful and deformed right elbow and was referred for radiography of his right elbow.
lateral elbowThe elbow is overflexed. It is likely that this is the position that the patient presented with and the radiographer correctly did not change the position for the initial series. There are fractures of the olecranon and radial neck producing an unstable elbow joint.
axial elbowIrrespective of whether the axial view was the best view for demonstrating these fractures, the patient wouldn't (and shouldn't) move his elbow and the radiographer correctly performed an axial view to provide the referring doctor with two vies at 90 degrees.



Case 4
This 7 year old girl Presented to the Emergency Department after falling onto her left elbow . She was examined and found to have a painful and swollen left elbow and was referred for radiography of her left elbow.
lateral elbowThe elbow is in a true lateral position.

The lateral elbow image demonstrates anterior and posterior fatpad signs indicating intra-articular injury. (top arrows)

A subtle cortical defect is noted in the dorsal aspect of the olecranon (bottom arrow)
AP elbowThe AP elbow view image demonstrates a fracture of the olecranon. (arrowed)


Case 5

This 38 year old man presented to the Emergency Department after an unknown injury . He was found to have a painful and swollen left elbow and was referred for radiography of his left elbow.
axial elbowThe elbow is in an acceptable lateral position.

There are anterior and posterior fat pad signs indicating intra-articluar injury. (top white arrows)

There is a fracture of the olecranon process.
AP elbowThe AP elbow view was performed with the forearm in contact with the IR. Whilst this is the better position for demonstrating the forearm anatomy, it has the disadvantage of potential underexposure of the upper arm (as in this case).

No displaced fracture is demonstrated.
axial elbowAn axial elbow view was performed which suggests that the fracture of the olecranon process is largely undisplaced