Olecranon Stress Fractures Research Articles

Elbow Injuries in the Throwing Athlete.

Overhead throwing athletes place a substantial amount of stress on the elbow during the throwing cycle. In athletes such as baseball players, repetition leads to attritional damage to the elbow. While injury to the medial ulnar collateral ligament is the most publicized, and perhaps most important, of these conditions, a collection of other disorders commonly afflict this population. These injuries include (1) ulnar neuritis, (2) flexor pronator injury, (3) medial epicondylar apophysitis or avulsion, (4) valgus extension overload syndrome with posterior impingement, (5) olecranon stress fractures, and (6) osteochondritis dissecans of the capitellum1. The purpose of the present review article is to describe the biomechanics of the throwing motion and the diagnosis and treatment of elbow injuries common to a thrower other than injuries to the ulnar collateral ligament. The osseous anatomy of the proximal part of the ulna and the olecranon fossa provides primary stability at 120° of flexion. The radial head provides secondary restraint to valgus stress at 30°. The primary coronal stability during the functional arc of an overhead …

Classification of Olecranon Stress Fractures in Baseball Players

Background: Although the onset mechanism of an olecranon stress fracture (OSF) due to a throwing disorder is believed to involve valgus extension overload, olecranon posteromedial impingement, or triceps traction force, this issue is still debated in the literature. Purpose: To establish a classification system for the different types of OSFs to improve diagnosis and clarify the onset mechanism. Study Design: Case series; Level of evidence, 4. Methods: A total of 200 baseball players (198 male, 2 female; mean age, 16.1 years; age range, 13-27 years) who were diagnosed with an OSF from January 1987 to July 2012 were studied. Combined disorders as well as the direction and form of the fracture line were analyzed on plain radiographs, computed tomography, and magnetic resonance imaging. Furthermore, the presence or absence of ulnar collateral ligament (UCL) injuries and avulsion fractures of the lower pole of the medial epicondyle was determined by imaging findings to calculate the combined percentage of OSFs. In addition, the prevalence of OSFs was evaluated among patients who were evaluated between April 2008 and March 2011 for throwing elbow disorders. Results: There were 5 types of OSFs identified in the new classification system: physeal, classic, transitional, sclerotic, and distal. The physeal type was further separated into stages 1 to 4 based on severity. The mean age for each type identified was as follows: physeal, 14.1 years; classic, 18.6 years; transitional, 16.9 years; sclerotic, 18.0 years; and distal, 19.6 years. A concomitant UCL injury and/or medial epicondyle avulsion fracture was diagnosed in 71% to 95% of cases, depending on the OSF type. Among baseball-related elbow disorders, the incidence of OSFs was 5.4%. Conclusion: This study presents a new classification system for the different types of OSFs based on the origin and direction of the fracture plane. This new system was strongly influenced by the age at symptom onset. Such information is essential for successful open reduction and internal fixation by ensuring that fixation pressure is perpendicular to the fracture plane, which will avoid the recurrence of stress fractures. In addition, the prevalence of UCL injuries suggests that it is a major risk factor for the development of OSFs.

Olecranon Stress Fractures Treated with Cannulated Screw Fixation in Baseball Players Results in Healing and Return to Play but with a High Rate of Reoperation

Olecranon Stress Fractures Treated with Cannulated Screw Fixation in Baseball Players Results in Healing and Return to Play but with a High Rate of Reoperation

Cannulated Screw Fixation of Refractory Olecranon Stress Fractures With and Without Associated Injuries Allows a Return to Baseball

Background: An olecranon stress fracture is a rare injury associated with valgus extension overload in baseball players. No long-term outcomes studies have been published documenting the results of surgical fixation of olecranon stress fractures with or without concomitant injuries in baseball players. Hypothesis: Open reduction and internal fixation (ORIF) of an olecranon stress fracture will reliably produce bony union and allow a successful return to the previous level of activity in competitive baseball players. Study Design: Case series; Level of evidence, 4. Methods: Twenty-five patients treated with ORIF for an olecranon stress fracture at least 2 years earlier (range, 2-10.14 years) were retrospectively contacted to complete a telephone survey; 18 of 25 (72%) patients responded. Data were collected to determine the return to play rate, level of arm pain, and overall arm function. Results: All 18 stress fractures went on to successful union; 17 of 18 (94%) athletes returned to baseball at or above their previous level. Average return to play time was 29 weeks. The numeric analog pain score was 0.2 at rest and 0.3 when throwing at the time of follow-up, at an average 6.2 years (range, 2.0-10.14 years) after surgery. The average score at follow-up on the Disabilities of the Arm, Shoulder and Hand Outcome Measure–shortened version (QuickDASH) was 4.1 (range, 0-27.3). Ten (56%) patients required 13 additional future surgeries on their throwing arm; 7 surgeries in 6 (33%) patients were not related to the index surgery. Six of 18 (33%) patients underwent hardware removal, with 2 (11%) for infection. Conclusion: Open reduction and internal fixation of olecranon stress fractures in competitive baseball players has a high rate of success in returning players to or above their former level of play and allows for good elbow function at an average of 6.2 years postoperatively. However, these patients are at high risk for additional future surgeries on their throwing arm.

Recurrence of an Olecranon Stress Fracture in an Elite Pitcher After Percutaneous Internal Fixation

Recurrence of an Olecranon Stress Fracture in an Elite Pitcher After Percutaneous Internal Fixation

Ulnar collateral ligament tear and olecranon stress fracture nonunion in a collegiate pitcher

Ulnar collateral ligament tear and olecranon stress fracture nonunion in a collegiate pitcher

Olecranon stress fracture in an adult baseball pitcher

Department of Orthopaedic Surgery, Shimane University School of Medicine, Shimane, Japan The authors have no financial disclosures. Correspondence to Shinji Imade, MD, Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane, 693-8501, Japan Tel: +81 853 20 2242; fax: +81 853 20 2236; e-mail: [email protected]

Elbow Pain and Injury in Young Athletes

Elbow pain and injury in young athletes include both acute traumatic and chronic overuse injuries. The anatomy of the developing pediatric elbow and the rapid growth of youth sports have led to an increase in chronic repetitive stress elbow injuries in the pediatric population. These injuries occur mostly in overhead athletes, throwers, and gymnasts. Force dissipation during throwing or axial loading results in lateral compression elbow injuries such as Panner's disease and osteochondritis dissecans of the capitellum or radial head. Medial distraction forces are responsible for medial injuries such as UCL failure, medial epicondyle apophysitis, and avulsion. Valgus extension overload causes posteromedial elbow impingement, olecranon apophysitis, and olecranon stress fractures. Conservative treatment modalities such as activity modification and physical therapy are successful in most cases, but early recognition is important as delays in diagnosis may prolong symptoms and necessitate operative intervention.

Medial Ulnar Collateral Reconstruction with Interference Screw Fixation: Retrospective Review (SS-68)

Multiple fixation methods have been described in MUCL reconstruction of the elbow. This study evaluates whether interference screws provide a viable alternative allowing throwing athletes a more rapid return to play at a pre-injury level or higher. A retrospective review from 2002 to 2005 identified 10 patients who had undergone MUCL reconstruction with tripled palmaris autograft or semitendinosis allograft with interference screw fixation and were throwing athletes. A minimum one year followup clinical outcome assessment was performed to determine efficacy of this technique in restoring elbow function. A chart review and subjective follow-up was done for the 10 patients meeting the inclusion criteria. 9 of 10 patients reached or exceeded their pre-injury level of play following reconstruction. Time to return ranged from 4-12 months with a mean of 6 months. One patient did return to sport but elected not to continue as his expectations regarding level of function were not met. There were no fixation failures and all patients achieved a stable elbow with good range of motion. One complication unrelated to fixation occurred 2 years post surgery consisting of medial olecranon stress fracture, which healed completely following brief period of rest. Interference screws with tripled tendon graft provide a viable alternative in MUCL reconstruction for throwing athletes, allowing earlier return to sport and satisfactory function in 90% of patients.

Nonunion of Olecranon Stress Fractures in Adolescent Baseball Pitchers: A Case Series of 5 Athletes

Nonunion of Olecranon Stress Fractures in Adolescent Baseball Pitchers: A Case Series of 5 Athletes

Olecranon Stress Fracture in a Young Tower-Diving Swimmer

This article presents the clinical and radiological features of olecranon stress fracture in a young diver with particular emphasis on caution associated with this condition.

Nonunion of Olecranon Stress Fractures in Adolescent Baseball Pitchers

Background Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention. Purpose To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities. Study Design Case series; Level of evidence, 4. Methods Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding. Results Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks). Conclusion Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Nonunion of Olecranon Stress Fractures in Adolescent Baseball Pitchers: A Case Series of 5 Athletes

Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention.To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities.Case series; Level of evidence, 4.Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding.Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4-16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7-13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1-33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4-28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9-40.4 weeks).Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Chondromalacia of trochlear notch after healing of olecranon stress fracture: a case report

Chondromalacia of the trochlear notch and stress fracture of olecranon are uncommon injuries in the throwing athletes. We report an 18-year-old high school pitcher who had persistent postero-lateral elbow pain after a healed olecranon stress fracture of the right elbow. Diagnostic arthroscopy revealed chondromalacia of the trochlear notch. After treatment with arthroscopic drilling and abrasion chondroplasty, he returned to competitive pitching 1 year later postsurgery. This rare association between chondromalacia and stress fracture of the olecranon has not been reported previously in the literatures. Chondromalacia of the trochlear notch should be included as a differential diagnosis in evaluating athletes with persistent elbow pain after healed olecranon stress fractures.

Elbow injuries in throwing athletes: a current concepts review.

Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.

小児における肘頭ストレス骨折の一例

小児における肘頭ストレス骨折の一例

Bony overuse injuries about the elbow

Elbow injuries are becoming increasingly common, especially among racquet and throwing sport athletes. Treatment of overuse injuries of the elbow continues to evolve. The purpose of this report is to discuss some of the more common bony overuse injuries of the elbow including osteochondritis dissecans of the capitellum, olecranon stress fractures, and valgus extension overload. Other less common entities include osteochondritis dissecans of the trochlea and medial epicondyle injuries. Diagnosis, current treatment recommendations, and rehabilitation are discussed.

Stress fractures of the upper limb.

Stress fractures are commonly found in the lower limb, but also occur in the upper limb, and are particularly associated with upper limb-dominated sports such as tennis and swimming and those involving throwing activities. Stress fractures of the clavicle and scapula are rare but have been reported, whereas those of the humerus are more frequent and have been described mainly in adolescent baseball pitchers. Olecranon stress fractures occur in throwers and gymnasts. Stress fractures of the ulna and radius have also been reported in a number of different upper limb-dominated sports. In all cases, these fractures heal with conservative management. The physician should consider stress fracture as a possible diagnosis in cases of upper limb pain of bony origin where the pain is associated with overuse.

Oblique stress fracture of the olecranon in baseball pitchers

The action of throwing places significant demands on the shoulder and elbow. These motions create a compression force on the lateral compartment, a distraction force on the medial side, and both shear and distraction forces on the posterior compartment of the elbow, s The throwing injuries of the elbow include osteochondritis dissecans of the capitellum, medial epicondylitis, 12 medial collateral ligament (MCL) injury, 1 and posteromedial osteophytes. 1 ~s Stress fractures are common injuries in the athletic population. Although stress fractures occur more frequently in the lower extremities, several cases of olecranon stress fractures have been reported. 4+,9nl The stress fractures through the physis or the persistence of the olecranon physis are seen in adolescent athletes, 5'6, ;1 and the stress fractures of the olecranon with an oblique fracture line have been reported in throwing athletes with a closed physis. 4, 9, lo In this article we report two olecranon stress fractures with oblique fracture lines and discuss the pathomechanics of this type of olecranon stress fracture.

Olecranon Stress Fractures in Throwers A Report of Two Cases and a Review of the Literature

The evaluation and treatment of elbow injuries in throwing athletics has been the topic of numerous articles. The intense and repetitive stresses placed on the elbow may, in rare instances, produce undisplaced olecranon stress fractures. Two cases are presented and the literature is reviewed to propose that the fractures can be successfully treated by conservative methods.