Throwing Pains - Page #4

Working Diagnosis:
Left Olecranon Stress Fracture

Open Reduction Internal Fixation Case Photo #3

Post-operative Course:
-Sling 10-14 days, then gentle AROM avoiding full flexion.
-No lifting or vigorous exercise, PROM stretching: no forceful flexion, AAROM and AROM at elbow, wrist, shoulder, Aquatic therapy, neuromuscular retraining, postural retraining.
-Physical Therapy one time per week for eight weeks after sling.
-1 month post-op able to resume all activities except heavy lifting and pitching.
-2 month post-op start slow, progressive return to throwing.
-4 month post-op no restrictions
-6 month post-op return to competitive throwing. Started in first game and won game.
4 month post-op no restrictions

Author's Comments:
Following surgery our athlete has regained full range of motion and full strength.

The most common mechanism of olecranon fracture is direct trauma or fall on a semi-flexed supinated forearm. A fulcrum is created by the triceps and distal humerus. The fracture is seen mostly in adults who present with elbow effusion. Thorough physical exam with assessment of neurovascular structures. Ulnar neurapraxia and paresthesias are seen in 2-5% of cases. These injuries are usually treated conservatively with casting in 90-135 degrees of flexion for 3 weeks. Nonunion of fracture may result in decreased extensor power.
Our athlete underwent surgery because of lack of extension, dominant throwing arm affected, and timing of injury (preseason).

Editor's Comments:
I would have liked to see whether or not the ulnar nerve was involved by history or exam. Did he have any other risk factors for stress fracture? Excellent case overall

Pritchett J, Porembski M A. Olecranon Fractures. eMedicine. 2009 Dec 3;1-21.

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