Anterior Olecranon Fracture-Dislocations of the Elbow in Children

Abstract

A subset of olecranon fractures with loss of normal articular apposition (subluxation or dislocation) is recognized in adults as anterior and posterior olecranon fracture-dislocations1-6, but such injuries in skeletally immature patients have been rarely described7-9. The anterior olecranon fracture-dislocation may resemble an anterior Monteggia lesion in that there is anterior dislocation of the radial head with respect to the capitellum; however, the forearm (the radioulnar relationship) remains intact and the injury is primarily to the ulnohumeral joint by means of disruption of the trochlear notch (Figs. 1-A and 1-B). The coronoid is fractured in approximately half of the patients, the radial head is rarely injured, and the collateral ligaments are generally spared10. Olecranon fractures are relatively uncommon in skeletally immature patients11-13, and we were able to identify the cases of only three skeletally immature patients with an apparent anterior olecranon fracture-dislocation reported in the literature7-9. Figs. 1-A and 1-B Drawings differentiating between anterior olecranon fracture-dislocation and anterior Monteggia injuries. Fig. 1-A In the anterior olecranon fracture-dislocation, the proximal radioulnar joint remains aligned and intact, but there is an anterior dislocation of the radiocapitellar joint along with the rest of the forearm. Fig. 1-B In the anterior Monteggia fracture, there is a fracture of the ulna with anterior dislocation of the radial head. We identified four skeletally immature patients with an anterior olecranon fracture-dislocation from a fracture registry. This report describes the injury characteristics, treatment methods, and results of these four patients. ### Materials and Methods Between 1974 and 2002, all fractures treated at our institution were entered into a database …