1. INTRODUCTION
A 13‐year‐old boy with an unremarkable medical and family history presented to the emergency department with right elbow pain. He had fallen on his right arm while playing soccer. Swelling and tenderness were noted on examination. A lateral radiograph at 90° elbow flexion showed that the olecranon epiphyseal line was slightly avulsed. Initially, surgery seemed unnecessary. Just to be sure, we confirmed the injured site stability via x‐ray fluoroscopy. Bone fragments were clearly displaced on elbow extension and deep flexion of more than 90° (Figure 1).
FIGURE 1.
The epiphyseal line of the olecranon appeared to be slightly avulsed (arrow) in a lateral radiograph taken with the elbow flexed at 90° (upper right of the figure). Bone fragments were clearly displaced (arrows) on deep flexion position of more than 90°and elbow extension (lower of the figure). The unaffected left side is shown in the upper left of the figure
2. DIAGNOSIS
2.1. Apophyseal‐metaphyseal combination fracture of the proximal ulna (olecranon)
There is no standard method of treatment because of the rareness of this fracture. 1 Children with osteogenesis imperfecta are predisposed to this injury.2 We determined that, in this case, the bone fragments were easily dislocated. Open reduction with internal fixation using tension band wiring was performed for management. Six months post surgery, the implants were removed; the elbow joint flexed to 140° and extended to 0°.
Complete fracture to the apophysis of the olecranon can be classified as a pure apophyseal avulsion or an apophyseal‐metaphyseal combination, 1 as in our case. The triceps tendon inserts into the metaphysis distal to the physis, creating a large avulsion force across the apophysis. 2 This anatomical structure may be the reason the fragments were not severely displaced.
In the emergency department, it is crucial not to underestimate this fracture; therefore, 2 general radiographic views (anterior‐posterior and lateral view at 90° elbow flexion) were necessary.
Ito H, Takeda S, Mitsuya S, Fukui J, Yamauchi K‐i. A young boy with elbow pain. JACEP Open. 2022;3:e12647. 10.1002/emp2.12647
REFERENCES
- 1. Kasser J, Flynn J, Skaggs D, et al. Rockwood and Wilkins' Fractures in Children. 7th ed. Wokters Kluwer/Lippincott, Williams and Wilkins; 2010:405‐445. [Google Scholar]
- 2. Fox D, Carney JR, Mazurek MT. Displaced apophyseal olecranon fracture in a healthy child. Mil Med. 2007;172:1225‐1227. [DOI] [PubMed] [Google Scholar]