Went over the handlebars and did a faceplant only blocked by elbow impact on the pavement. Ended up fracturing my olecranon. While the break goes completely through the bone, the piece is not displaced (according to the doctor this is unusual). My options are to remain in a splint and take some time to see if the bone begins to fuse on its own, or to go the fixation route, which sounds like a much faster and more certain recovery. I am leaning towards fixation.
My concern is that the fixation will limit swimming flexibility. Also, I know I rest on my forearms (not elbows) when aero, but could the pins cause irritation when in the aero position for long periods of time?
Anybody with any experience care to chime in? Any prolonged side effects or negative aspects of the surgery that have been encountered firsthand?
In the meantime my face looks like I got into a boxing fight and I have a very self-deprecating story to tell once I have healed (probably the single most moronic crash ever).
Slim - why have an operation if you don’t need it? If it’s truly a non-displaced fracture, serial x-rays by your Orthopod will reveal displacement if it occurs (thus necessitating surgery). Were you my patient that’s what I’d recommend.
John,
thanks a lot for answering, this is the type of response I am looking for.
My understanding is that the bone can easily become displaced during the healing and that I risk a non-union if I wait too long. the 6 weeks in a sling is not very appealing either (versus a much shorter rehab from the fixation). My doctor actually wants to wait longer too, but I dont really see the benefit. If a displacement were to occur later in the process it would just set my recovery back even further. Do you think that I am overestimating the probability of displacement? Is a non-displaced olecranon really that rare? I cant find any real data.
I suppose I just feel strange being so passive waiting for it to heal. 6 days of immobility is already making me really crazy.
SF - I read somewhere that in the fracture repair process, the fracture site is the weakest on the 7th or 8th day post injury when the “dust” at the fracture site has been reabsorbed as part of the normal repair process. Follow up x-rays taken a few days after the fracture, and then at predetermined intervals, will reveal displacement should it occur, less likely the farther out you are. I think your doc has done and excellent job teaching you the risks/benefits and you’ve done likewise remembering them.
In the end, though, you have to do what makes you comfortable.
HI, I fractured my olecranon in a bike crash a little over 2 weeks ago - after 10 days I went to the removable brace and I go back tomorrow to check to make sure everything is growing properly. However, I am concerned, because in this removable brace - I can take it off to shower - and I know that I am no where near able to bend my elbow. I thought by this point - about 16-17 days I would have made more progress. I broke my collarbone and after 3 weeks I was able to ride again and it felt significantly better. Is this normal with an olecranon fracture? And how long should I expect before I start to see some range of motion? Thanks so much for any advice!
Sorry to hear about your injury. The truth is, the elbow is no clavicle. Also, the degree of comminution (number of pieces) also makes a difference. Your doc will show you a range of motion program and if you get a little behind, turn you over to PT for a “beating”. Just kidding. PT has all the tricks needed to get these moving but I’d imagine you’re a ways from unprotected use in the lap lanes. Good luck!
OK, thank you for the quick reply! I know it was only fractured, and not displaced, so do you think by 4 weeks post it will at least be doing some flex and extension ? I am fine with 4 weeks, but was really hoping that after a month I would at least be able to resume mostly normal activities. Thanks again!
As I said on the other thread it took me more than 2 months to get full ROM. My doctor told me that of all the joints in the body, the elbow locks up more severely from a trauma than any other joint. I found it incredibly frustrating and after a few weeks wondered if I would ever get ROM back. It was extremely painful working on the exercises but after a month or so I got more aggressive with the exercises and gradually ROM came back.
You didn’t say whether the olecranon was displaced or angulated from the triceps pull. Biceps contracture is very common. But you should have some elbow flexibility at 17 days out. I think it’s time for you to have a forearm/elbow reassessment.
quote evk78]HI, I fractured my olecranon in a bike crash a little over 2 weeks ago - after 10 days I went to the removable brace and I go back tomorrow to check to make sure everything is growing properly. However, I am concerned, because in this removable brace - I can take it off to shower - and I know that I am no where near able to bend my elbow. I thought by this point - about 16-17 days I would have made more progress. I broke my collarbone and after 3 weeks I was able to ride again and it felt significantly better. Is this normal with an olecranon fracture? And how long should I expect before I start to see some range of motion? Thanks so much for any advice!
I don’t think it was displaced, I do have more movement than 2 weeks ago, but I just thought it would be more, I have an appointment tomorrow, to see if we can change the degrees on this brace I am wearing. I will let you guys know what he says tomorrow, I am just concerned because it seems like so many people have had various results. I am 25, so hoping that at 1 month will have better ROM, thanks for any advice!
Good to hear that you see the doc tomorrow. Chances are that the brace will be unlocked and you will start PT soon. Ask about aquatic therapy that you might do. Best wishes!
I would want to get it fixed ASAP. April 21 would be too long to wait for me. In fact, if you get to April 21 without surgery, at that point you might as well just wait for it to heal.
I suspect, although I don’t know because I haven’t seen your x rays and I am not an orthopod, that a non displaced olecranon fracture could be pretty well fixated with two screws through a pretty small incision. This would get you to PT almost immediately and would get you healing and back to activity sooner.
I also suspect that a couple of screws will not affect your swimming mobility or your aero position much at all. You might have some mobility issues but it will probably be from the injury, not from the fixation.
As I often say, this advice is worth what you paid for it…
I did end up getting the surgery shortly after posting this. I was in a cast then sling for almost 8 weeks. Started PT at 6/7 weeks and was swimming and cycling after around 12-15 weeks (I could run as soon as I started PT).
From my research and my doctor’s explanation, the tricep pulls the olecranon away from the shaft of the bone naturally. This is why the injury is so easily displaced and why it often does not heal on its own. If you wait too long and the break does not fuse it brings all sorts of other complexities into the equation and could extend recovery significantly because the bone wont fuse after some amount of time. It was a bit of a gamble for me to continue waiting for my elbow to heal on its own, so I was advised to go with the fixation surgery. I was told that the fixation actually accellerated the bone’s fusing process (due to compressing foces applied by the screws/wires) versus letting it heal fully on its own.
Fixation stabilizes the break and makes it much more strong while it is healing (again, compression of the bone). If you let the bone fuse on its own, it is a fragile process, and you cannot rush it. You have to be very careful with it while it is healing to avoid displacing it.
In summation, it takes time for the bone to regenerate. Furthermore, the PT is no walk in the park. You may be getting some range back (the first part comes quickly), but the hard part is getting that last little bit of range in order to fully straighten your arm. You will have also lost a lot of the muscle in your arm. The good news is that I fully recovered and have full range of motion and strength.
slimfast - thanks for the info. I saw two ortho’s within the first 10 days of my fracture and neither mentioned the possibility of surgery, so I assume that mine must not be so severe? The first ortho I saw told me to expect to be able to ride after 6 weeks. The second did not really mention that, but said it should feel significantly more mobile after 3, it’s been exactly 2.5, so I am skeptical of the 3 week benchmark. Will give update after tomorrow’s appointment. Keeping my fingers crossed for good news.
Well looks like what you guys said is more on track than my original expectations. Because so many muscles attach there and it is a joint with cartilage, etc., it takes more time than something like a clavicle (as mentioned). The doc said that at 2.5 weeks it wouldn’t be expected to see anything new on xray (we didn’t), but adjusted my brace to allow more movement and gave me an exercise to work on during the next 2 weeks (lay on my back with my arm against the couch or bed and with a can in my hand lower my arm towards the couch, back up, down, so on for 30 min 2Xday. And after a few days I should be able to get it down further (right now it isn’t going too far but that is because it is so tight he said from not using it). I plan to do this every day in hopes of being able to reach my shifters next week to use the trainer. He said I shouldn’t expect to notice significant difference until about 6 weeks - is this what you guys experienced? For instance, how long until swimming or lifting weights? Bummed, but I thought I wouldn’t make it 3 weeks and i have, so I guess I can go 3 more! At least running, stairmaster, and leg machines are doable.
So anybody remember how long it was until you could begin lifting weights or doing something like the row machine? I am at 3 weeks, was given one PT exercise to do and go back in another week and a half. Doc said by 6 weeks I should notice significant difference in how it feels (I guess by that point new bone will have formed). Just trying to give myself something to look forward to and how long I will have to wait to start trying to build back the muscle in my arm!
Your doc has chosen the conservative (nonoperative) management, probably because the fracture is unlikely to become displaced while union of the bone takes place. X-rays at 8 weeks will hopefully confirm union. After that, most therapy protocols begin arm aerobic exercises and some light resistance exercises. In the case of olecranon fracture, actual weight lifting to rebuild muscle starts on average at about 10-12 weeks. Ask your doc about doing stationary cycling and safe treadmill workouts. Do nothing that might increase your risk of falling. Also ask about when you can start aquatic resistance exercise/ swimming. You should regain most (but not 100%) of your upper-body fitness by 4 months post-injury.
Stay positive!
So anybody remember how long it was until you could begin lifting weights or doing something like the row machine? I am at 3 weeks, was given one PT exercise to do and go back in another week and a half. Doc said by 6 weeks I should notice significant difference in how it feels (I guess by that point new bone will have formed). Just trying to give myself something to look forward to and how long I will have to wait to start trying to build back the muscle in my arm!
Hi AndrewPhx,
I was able to start PT this week (after 4 week xray looked good). So I was given about 3 different things to do each day, 3-4 sessions per day. But they HURT. The PT said that is because all of the joint fluid is dried up due to the immobilization for so long. I was wondering what your experience was with PT - did you see quick improvements and lessening pain? I am now able to eat with my right arm! so yay, that was progress in the last 2 days. Hoping for 2 weeks of being committed to it that I will see big improvements in ROM and some strength?