![]() The goals of treating olecranon fractures are anatomic restoration of the articular surface, repair of the elbow extensor mechanism, restoration of joint stability and motion, and prevention of stiffness and other complications. Briefly, Type A fractures are extraarticular metaphyseal fractures, Type B are intraarticular fractures of either the proximal radius or ulna, and Type C are intraarticular fractures of the radial head and olecranon. The AO classification of proximal radius and ulna fractures tends to be used more frequently for research purposes. The Schatzker classification subdivides fractures based on their pattern into transverse, transverse-impacted, oblique, comminuted with associated injuries, oblique-distal, and fracture-dislocation. The Mayo classification, based on displacement and ulnohumeral joint stability, is our preferred choice as it can be used to guide treatment: Type I, nondisplaced fractures, treated nonoperatively Type II, displaced, stable fractures that require operative fixation and Type III, displaced, unstable fractures that require operative fixation. The challenges of testing the reliability of classification systems have been discussed in the literature, and this is reflected in the presence of several classification systems still in use for olecranon fractures as each serves a different purpose. Each classification system is subject to interrater variability, and none has been proven to be more reliable than the other. Several classification systems have been described but neither has been universally accepted. More advanced imaging rarely is indicated for isolated olecranon fractures. Radiographs should be examined carefully for evidence of coronoid process fracture, dislocation of the elbow, and radial head injury. It is essential to obtain a true lateral radiograph of the elbow to evaluate the extent of the fracture, degree of displacement and comminution, and the degree of articular surface involvement. Isolated olecranon fractures can be identified appropriately with standard AP and lateral radiographs of the elbow. It is extremely important to closely examine the skin for any openings given the subcutaneous location of the ulna. A palpable defect can be appreciated if there is substantial displacement of the fracture. Diagnosis of any upper extremity injury begins with a thorough physical examination of the entire extremity, including observation, palpation, and complete neurovascular examination. The typical presentation for a patient with an olecranon fracture is with elbow pain and swelling and inability to extend the elbow against gravity.
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