Olecranon fracture

　　The olecranon fracture of the ulna is a common fracture, mostly occurring in adults, and the causes include direct external force injury and indirect external force injury.

　　Direct external force injury: When falling, the elbow joint is extended and the elbow lands, or it is directly struck to the back of the elbow, causing comminuted fracture, and the fracture ends are mostly not separated.

　　Indirect external force injury: When falling, the elbow joint is in a straightened position, the external force is transmitted to the elbow, and the triceps brachii muscle pulls to cause a avulsion fracture. The fracture line may be transverse or oblique. The two fracture ends are separated.

　　The olecranon fracture of the ulna is caused by direct or indirect external force injury. Non-displaced fractures may swell and be tender. Fractures with displacement and fractures with associated dislocation have a wider range of swelling. The following complications may occur if the treatment and maintenance of this disease are not proper:

　　1, The non-union of fractures is relatively rare, with an incidence rate not exceeding 5%. It is often due to the gap at the fracture end, which causes fibrous healing. If the gap is small, there exists strong and thick fibrous tissue between them;

　　2, The functional disorder of the elbow joint is relatively rare. If the gap is large, there exists elongated fibrous tissue that is easy to be stretched between them, which is more likely to cause the degeneration of the extension function of the elbow joint, and even a slight violent force may cause the rupture of the fibrous healing site. After the fracture ends are separated, the distance between the origin and insertion of the triceps brachii muscle is shortened, resulting in the weakening of the extension force of the elbow joint.

　　When the fracture does not heal and there is severe pain or limitation of flexion and extension of the elbow joint, surgical treatment should be considered. Young patients can be treated with internal fixation and bone grafting. During the operation, attention should be paid to the removal of the ossified surface of the fracture ends, and whether it is necessary to fill the defect with a bone graft block and whether to use tension band wire fixation or plate fixation should be decided according to the specific situation. Regardless of the type of fixation, when applying axial pressure during the operation, attention should be paid to prevent the distance between the coronoid process and the olecranon process from shortening.

　　According to Eriksson et al. (1957) reported, up to 50% of patients have limited activity, especially extension limitation of the elbow, but it is not common in his reported cases, only 3%. Limited activity is often not serious and has little impact on daily function, often not attracting the attention of patients. It may be related to improper functional exercise and the tail of the fixation pin stimulating the dorsal side of the distal humerus, generally no special treatment is required. 10% of patients may have ulnar nerve symptoms, including numbness, decreased sensation, etc., but most can recover spontaneously without special treatment.

　　When olecranon fracture is non-displaced, symptoms such as swelling and tenderness may occur. Fractures with displacement and fractures with associated dislocation have a wider range of swelling. The posterior part of the elbow can be palpated for indentation, fracture fragments, and bone grinding sounds. The function of the elbow joint is lost.

　　Olecranon fracture is caused by trauma. In addition to paying attention to safety in production and life to avoid trauma, there are no effective preventive measures.

　　Prognosis: The olecranon is mainly composed of cancellous bone. After good reduction and stable fixation of the olecranon fracture, the fracture ends obtain close contact, heal quickly, and have a good prognosis. However, if the joint surface damage exceeds 60% or there is still displacement of more than 2 millimeters after surgery, the prognosis is poor.

　　The auxiliary examination for olecranon fracture mainly includes X-ray examination. The lateral X-ray film of the elbow joint can accurately grasp the characteristics of the fracture. The anteroposterior X-ray film is also very important, as it can show the direction of the fracture line in the sagittal plane. If the radius bone also fractures at the same time, there can be obvious shortening along the fracture line on the lateral X-ray film, and there is no angular or displacement.

　　Early local bleeding in fractures is severe, causing significant damage to the body. Added to this is the fact that the patient has to lie in bed all day, reducing physical activity, disrupting the original rhythm of life. Although most fracture patients do not have associated organ damage, there is often a decrease in appetite and a lack of desire to eat. This is more pronounced in elderly patients or those with weak constitution or poor psychological tolerance. Based on psychological care, more effort should be made in diet, paying attention to a balanced diet, with good color, smell, and taste to stimulate appetite. At this time, due to the accumulation of blood stasis and heat, and the excessive activity of the liver and gallbladder, symptoms such as low fever, thirst, and irritability may occur. Therefore, the diet should be light, easy to digest, and in addition to fresh vegetables and fruits, it is advisable to eat lean meat, eggs, and river fish, preferably steamed or in soup. Patients with difficulty in arm movement should be fed.

　　Due to less movement and stagnation of Qi due to worry and thought, there is often constipation, which is more common in bedridden patients. It is advisable to eat more vegetables rich in fiber and eat some bananas, honey, and other foods that promote defecation. If necessary, take medicine such as Maren Pill or liquid paraffin to relieve constipation. If constipation lasts for many days and there is too much feces retention, abdominal distension and abdominal pain, you can use 30 grams of senna leaves to make water for tea.

　　In the middle stage of fracture, the local swelling gradually subsides, the pain decreases, the appetite increases, and the bone enters the growth period. At this time, it is advisable to eat small and frequent meals. You can eat some food such as eel, snakehead, turtle, pigeon, quail, etc., and it is better to steam or boil them. Accompanied by traditional Chinese medicine such as safflower, codonopsis, and wolfberry, they can become medicinal food to nourish Qi and blood, and accelerate healing.

　　In the late stage of fracture, the callus heals, and the function training begins, which can restore normal diet, ensure nutrition and energy.

　　Olecranon fracture is an intra-articular fracture, and the treatment requires a flat articular surface and the quickest recovery of joint function. The specific method of treating olecranon fracture should be adopted according to the degree of injury and the classification of fracture.

　　1. Simple solid splint fixation:Applicable to olecranon avulsion fracture or non-displaced fracture. Extend the elbow joint. Fix it with a plaster splint or splint for 2-3 weeks, and start exercising after removing the external fixation.

　　2. Manual reduction and fixation with a plaster splint or splintApplicable to olecranon fracture. The reduction method keeps the elbow semi-flexed, relaxes the triceps brachii, and makes it easy to push the fracture fragment back to its original position with the fingers. The elbow is fixed in an extended position with a plaster splint. Start exercising after removing the splint for 3-4 weeks.