Olecranon Stress Fractures Research Articles

Olecranon Stress Fracture Treated with Headless Compression Screws and Bone Marrow Aspirate Concentrate Augmentation: A Case Report and Systematic Review of the Literature

Olecranon Stress Fracture Treated with Headless Compression Screws and Bone Marrow Aspirate Concentrate Augmentation: A Case Report and Systematic Review of the Literature

Elbow Arthroscopy for Posteromedial Impingement and Fixation of Olecranon Stress Fracture

Posteromedial elbow impingement due to valgus extension overload often develops as a result of excessive valgus and extension force during repetitive overhead throwing activities. Impingement classically occurs in throwing athletes such as baseball, tennis, softball, or lacrosse players. If isolated, arthroscopic removal of the posteromedial olecranon osteophytes shows excellent postoperative satisfaction, return to sport rates, and return to previous level of activity. This Technical Note describes treatment of posteromedial elbow impingement syndrome and associated olecranon stress fracture treated with arthroscopic removal of posteromedial osteophytes and arthroscopic-assisted screw fixation.

Retrograde headless compression screw fixation of olecranon stress fractures in throwing athletes: a novel technique

An olecranon stress fracture (OSF) is a rare injury most commonly seen in high-level overhead throwing athletes with no clear consensus on surgical treatment. The most common surgical treatment described in the literature is cannulated screw fixation but there have been high rates of reported hardware irritation and need for subsequent hardware removal. This study describes a novel surgical technique in the treatment of OSFs in high-level throwing athletes using retrograde headless compression screws. We hypothesized that patients would have excellent outcomes and decreased rates of hardware irritation postoperatively. A retrospective review of competitive-level throwing athletes who sustained OSFs that were treated operatively using a novel technique using retrograde cannulated headless compression screws to avoid disruption of the triceps tendon. Postoperative outcome measures obtained included the Disabilities of the Arm, Shoulder and Hand score, Mayo Elbow Performance Score, Simple Elbow Test score, Single Assessment Numerical Evaluation score, Visual Analog Scale, arch of motion, and time to return to sport as well as level returned to. Radiographs were obtained routinely at 2-week, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up. Five of 5 patients who met inclusion criteria were available for final follow-up. Mean age at time of surgery was 20 years (range 17-24). Mean follow-up was 17 months (range 4-33). All patients were baseball players, 4 of which were pitchers and 1 position player. All patients were able to return to sport at the same level or higher at a mean of 5.8 months (range 3-8). Postoperatively, mean arch of motion was 138°, Visual Analog Scale score was 0, Single Assessment Numerical Evaluation score was 90, Disabilities of the Arm, Shoulder and Hand score was 2.0, Mayo Elbow Performance Score was 100, and Simple Elbow Test score was 12. There was no incidence of hardware removal. This study presents a novel surgical technique in the treatment of OSFs in high-level throwing athletes. The results presented demonstrate that this technique is safe and effective for getting athletes back to play quickly without any complications of hardware irritation which has previously shown to be a significant problem in prior literature.

Olecranon Tendo-Osseous Allograft Reconstruction for Complex Extensor Mechanism and Bone Loss at the Elbow

The purpose of this study was to present the results of olecranon tendo-osseous allograft (OTOA) reconstruction for patients with an irreparable extensor mechanism from prior trauma or failed total elbow arthroplasty (TEA). A retrospective review was performed of all patients with extensor mechanism loss after trauma or failed TEA who were treated with an OTOA to supplement fracture fixation or elbow arthroplasty, as indicated. Primary outcome measures were successful healing of the allograft, restoration of the extensor mechanism function, and Mayo Elbow Performance Scores (MEPS) at the most recent follow-up. Secondary outcomes included patients' active range of motion and unplanned operative interventions. Nine patients had extensor mechanism and proximal ulna loss as a result of prior TEA, acute trauma, or failed surgeries for prior trauma. All but one had undergone multiple prior surgeries. The mean follow-up was 27 months (6-60 months). At the final follow-up, patients reported MEPS of 92 (80-100). All patients regained active triceps extension (strength 3-5/5). Mean final range of motion was 16° (0° to 45°) extension, 124° (70° to 150°) flexion, 56° (45° to 80°) pronation, and 60° (40° to 80°) supination. Eight (89%) of the nine patients had a radiographically healed graft at the latest follow-up, of which four healed without notable complications or further surgical intervention. Complications included radial/ulnar nerve palsy, allograft olecranon stress fracture, deep infection, wound complications, instability, and complications related to the TEA prosthesis. In the setting of elbow reconstruction in which there is inadequate triceps tendon and/or olecranon bone stock to perform internal fixation and/or revision arthroplasty, OTOA may supplement elbow reconstruction, albeit with high rates of complications. A triceps-olecranon allograft, combined with either internal fixation or TEA, is a potentially useful salvage procedure for managing bone loss and an irreparable extensor mechanism deficit at the elbow. Therapeutic V.

Surgical Outcome of Bone Peg Fixation for Transitional Type of Olecranon Stress Fracture in Baseball Players

Surgical Outcome of Bone Peg Fixation for Transitional Type of Olecranon Stress Fracture in Baseball Players

Focused extracorporeal shock wave therapy for olecranon stress fracture in baseball players

Focused extracorporeal shock wave therapy for olecranon stress fracture in baseball players

Operative procedure of olecranon stress fracture in baseball players

Operative procedure of olecranon stress fracture in baseball players

Arthroscopy-assisted cancellous bone plug grafting for olecranon stress fractures in baseball players

Arthroscopy-assisted cancellous bone plug grafting for olecranon stress fractures in baseball players

Performance and Return to Sport Following Open Reduction Internal Fixation About the Elbow in Professional Baseball Players

Objectives: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon in professional baseball players with regards to return to sport (RTS) are unknown. The purpose was to determine the RTS rate and performance in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures, and to compare RTS rate and performance to matched controls. The authors hypothesized that there is a high rate of RTS in professional baseball players following ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance, specifically related to the primary outcome performance variables of win-loss percentage (W-L%), WHIP ((walks +hits)/innings pitched), fielding independent pitching (FIP), and wins above replacement (WAR)) between cases and controls between cases and controls. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (average age 22.6 +/- 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%), that was fixed with one screw (60%), with a RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the players. No significant difference existed between the primary preoperative and postoperative performance (change in performance) metrics for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (either acute, displaced or stress fracture) have a RTS rate of 67.5%, which is no different than natural attrition from matched controls. No decline in performance metrics is seen in players who are able to RTS when compared to their preoperative performance, or to the performance of matched controls.

Performance and Return to Sport After Open Reduction and Internal Fixation of the Olecranon in Professional Baseball Players

Background: The results of open reduction and internal fixation (ORIF) of stress reactions and fractures of the olecranon among professional baseball players with regard to return to sport (RTS) are unknown. Purpose/Hypothesis: To determine the RTS rate and performance of professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures and to compare the RTS rate and performance with that of matched controls. The authors hypothesized that there is a high rate of RTS among professional baseball players after ORIF of acute, displaced olecranon fractures and olecranon stress fractures with no significant difference in rate of RTS or performance between cases and controls. Study Design: Cohort study; Level of evidence, 3. Methods: All professional baseball players who underwent ORIF of the olecranon between 2010 and 2016 were included. Demographic and performance data (before and after surgery) for each player were recorded. Performance metrics were then compared between cases and a group of matched controls. Results: Overall, 52 professional baseball players (mean ± SD age, 22.6 ± 3.6 years) underwent ORIF of an olecranon fracture. The majority of players sustained a primary olecranon stress fracture (73%) that was fixed with 1 screw (60%), with an overall RTS rate of 67.5%. No difference in RTS rate existed between matched controls and the cases. No significant difference existed between the primary pre- and postoperative performance metrics (ie, change in performance) for pitchers who underwent ORIF of an acute, displaced olecranon fracture or ORIF of a primary olecranon stress fracture. No significant difference existed between pitchers who underwent ORIF of a primary olecranon stress fracture and matched controls in any of the primary performance metrics. Three cases and 2 controls underwent ulnar collateral ligament reconstruction later in their careers after olecranon ORIF. Conclusion: Professional baseball players who undergo ORIF of an olecranon fracture (acute, displaced, or stress) have an RTS rate of 67.5% (57.6% to the same or higher level), which is no different from natural attrition among matched controls. No decline in performance metrics was seen among players who were able to RTS when compared with their preoperative performance or the performance of matched controls.

Approach to Medial Elbow Pain in the Throwing Athlete.

Injury to the ulnar collateral ligament is the most common, significant injury affecting the medial elbow of the overhead athlete. However, there are many other significant sources of pathology that should be considered. This review seeks to present a broad range of conditions that providers should consider when evaluating the overhead athlete with medial elbow pain. Recent biomechanical studies have deepened understanding of the anatomy and function of the anterior bundle of the ulnar collateral ligament germane to the overhead athlete. Orthobiologics hold potential for expanding the role of non-operative treatment for ulnar collateral ligament injuries. In addition to injury to the ulnar collateral ligament, providers should be prepared to diagnose and treat valgus extension overload, proximal olecranon stress fracture, ulnar nerve pathology, common flexor - pronator mass injury, and, in adolescents, medial epicondylar avulsion, when managing medial elbow pain in the overhead athlete.

Stress Fracture of Olecranon after Plate Fixation for Osteoporotic Monteggia Fracture with Absence of Radial Head: A Case Report

Stress Fracture of Olecranon after Plate Fixation for Osteoporotic Monteggia Fracture with Absence of Radial Head: A Case Report

A Case of Olecranon Stress Fracture Caused by Throwing Motion

A Case of Olecranon Stress Fracture Caused by Throwing Motion

Elbow Surgery in Athletes.

Injuries and disorders of the elbow in athletes are common especially among throwing athletes. Common injuries encountered in the throwing athlete include ulnar collateral ligament injuries, ulnar neuritis, capitellar osteochondritis dissecans, valgus extension overload with posterior olecranon impingement, olecranon stress fracture, and loose bodies. A thorough knowledge of both the functional anatomy as well as throwing biomechanics are required to properly diagnosis and treat these problems. Nonoperative and surgical techniques have continued to advance over the last 25 years allowing for improved prognosis and return to play for athletes affected with elbow pathology.

Elbow Injuries in the Adolescent Thrower.

With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes.

Arthroscopic and Open Treatment of Olecranon Apophyseal Injuries in the Athlete

Elbow injuries are quite common in the athletic population with overhead throwing athletes at more risk than nonthrowing athletes. These injuries frequently manifest as acute traumatic events or sequela of chronic repetitive stresses on the stabilizing anatomical structures of the elbow. Overuse stress-related olecranon osseous injuries occur in both skeletally mature and immature athletes, and both nonoperative and operative treatment options have provided good outcomes. However, early identification of the injury and appropriate consideration of factors such as age, contralateral physeal closure, fracture displacement, sclerosis, and response to conservative care afford the best opportunity of success with the least risk for surgery, complication, or lost performance. The authors present an alternative classification scheme and treatment algorithm for olecranon injury, including arthroscopic and open surgical techniques for adolescent and young athletes with olecranon stress fractures and both mature and immature radiographic skeletal findings.

Treatment of Valgus Extension Overload

Valgus extension overload (VEO) can cause significant morbidity in the throwing athlete. VEO results from repetitive extreme valgus forces across the elbow and comprises a constellation of injuries located at the posteromedial compartment (osteophyte formation, olecranon stress fractures, and impingement), the ulnar collateral ligament (UCL), and the radiocapitellar joint (lateral compartment chondrosis). The following chapter provides an overview of the relevant anatomy, biomechanics, and diagnosis of VEO. It further details the arthroscopic surgical technique to successfully treat patients with VEO.

Medial Elbow Pain - Young Baseball Pitcher

HISTORY: A 14-year, 2-month old male right-handed baseball pitcher presented with chronic right medial elbow pain over 18 months, with no inciting injury/trauma. Initially he had mild right medial epicondylitis on magnetic resonance imaging (MRI) which resolved with rest and physical therapy. Still his right elbow pain recurred when throwing, ultimately failing conservative measures. Our collaborating orthopaedist then referred him to us for ultrasound and nonsurgical management. At his initial visit with us, he reported no pain at rest. He last had elbow pain one month earlier while doing lighter outfield (non-pitching) throws. PHYSICAL EXAMINATION: Afebrile with normal blood pressure and pulse. Normal muscle bulk and appearance for his age. Focused right elbow examination showed normal range of motion and no pain with flexion/extension. No locking or swelling. He did have laxity of his right elbow with valgus stress. DIFFERENTIAL DIAGNOSIS: 1. Valgus extension overload. 2. Osteochondritis dissecans. 3. Olecranon stress fracture. 4. Medial epicondyle avulsion fracture. 5. Medial apophysitis. 6. Medial epicondylitis. 7. Ulnar collateral ligament (UCL) sprain or tear. 8. Ulnar neuritis/subluxation. TESTS AND RESULTS: Initial MRI 18 months prior showed no UCL injury, but rather fluid at the flexor pronator mass consistent with medial epicondylitis. New MRI showed a partial right UCL tear at the proximal insertion. No full tear, fracture, or other connective tissue injury. Under ultrasound, laxity of the right UCL and pathology consistent with the partial UCL tear was seen, with no fracture, loose bodies, or epicondylitis. FINAL WORKING DIAGNOSIS: Partial UCL tear at the right elbow. TREATMENT AND OUTCOMES: We injected platelet rich plasma (PRP) under ultrasound to the pathologic site of the right UCL. The boy then proceeded with our 12-week PRP rehabilitation protocol tailored to throwing athletes. At 8 weeks post-injection, ultrasound showed interval healing with reduced laxity of the right UCL. At 16 weeks post-injection, ultrasound revealed virtually complete healing with no laxity of the right UCL. The boy eventually returned to throwing full pitching distance without pain, emphasizing the potential utility of PRP injection in pediatric/adolescent athletes with musculoskeletal injuries.

Olecranon Stress Fracture in Baseball Throwers

Olecranon Stress Fracture in Baseball Throwers

Olecranon Stress Injury in an Adolescent Overhand Pitcher: A Case Report and Analysis of the Literature.

Upper extremity stress fractures, which are relatively rare, have become increasingly common, with olecranon stress injuries representing a subset primarily affecting throwing athletes. Olecranon stress fractures have been classified to fit specific radiographic patterns, with most of these injuries typified by a fracture line. Only a handful of olecranon stress injury cases report magnetic resonance imaging findings of osseous edema within the olecranon, as in our case of a 17-year-old competitive overhand baseball pitcher with elbow pain. The patient was treated conservatively and had resolution of pain after 6 weeks of rest, followed by a 6-week throwing progression with full return to pitching.