Working Diagnosis:
Ongoing left olecranon stress fracture, now propagated to acute non-displaced fracture.

Treatment:
Patient elected to proceed with an ORIF of the left olecranon 02/2025 <a href="CaseStudyImages/CS4CS3CS2CS1Throwing-1397.jpg" title="Case Photo #4" data-lity><b>Case Photo #4</b></a> . Surgery went well and there were no complications. He was placed in a brace following the procedure with gradual unlocking via UCL post-operative reconstruction protocol. He was able to remove the brace for therapy activities.

Outcome:
Patient placed in a locked brace for 6 weeks post-op with gradual increase in motion with PT. He then progressed through a full-strength program 10 weeks post-op with a return to hitting program 12 weeks post-op and return to throwing program closer to 16 weeks post-op. Did well with minimal symptoms. Returned to throwing from a mound at 6 months post-op and was cleared for the spring season.

Author's Comments:
Non-surgical and surgical options were discussed with the athlete. There was potential for the fracture to heal with dedicated rest, though he would not have been able to participate in any throwing activity for a minimum of 10-12 weeks followed by a gradual return to throwing program. With this option, there was concern for an ongoing stress injury. Surgical option includes fixation with an intramedullary screw. Patient understood that he would have to wait 12-16 weeks post-surgery before a return to throwing program. This option reduced concern for an ongoing stress injury and offered the most predictable outcome. He was placed in a brace for 6 weeks post-op for initial recovery and attended rehab throughout.

Editor's Comments:
Elbow pain in a throwing athlete can be a somewhat daunting complaint at times. While stress fractures are on the differential there are several other soft tissue injuries that are more commonly the culprit. It is a good practice to have a system of how to approach and evaluate athletes with elbow pain. A case such as this is a good reminder to always keep a stress fracture on your differential even while considering or treating other diagnosis such as tendinopathy, impingement or an overload syndrome. In reviewing the literature these types of stress fractures are more commonly treated with surgery and end up with quicker return to play. We continue to study the data and cases such as this to monitor the best practices for return to play and overall complications with treatment.

References:
Talaski G, Yazdanpanah S, Smith M, ect. Short-term complications of open reduction and internal fixation of olecranon fractures: a national database study. JSES International, 2025; 9, 2156-2160 <br> <br>Smith SR, Patel NK, White AE, Hadley CJ, Dodson CC. Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review. Orthopedic Journal of Sports Medicine. 2018 Oct 8; 6 (10). <br> <br>Burnier M, Barlow JD, Sanchez-Sotelo J. Shoulder and Elbow Fractures in Athletes. Current Reviews in Musculoskeletal Medicine. 2019 Mar; 12 (1): 13-23.

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