She attended ED 5 weeks later because of persisting pain at the elbow though the swelling had settled. Soft tissue injury was diagnosed and no X ray requested.
She attended her GP a week later and after another week an X ray was done which showed the displaced olecranon fracture.
CT showed. Type III A displaced olecranon fracture with a 2.8 cm gap . Now, having the definitive treatment with fixation.
Lesson
If a patient has persisting pain, then there should be a lower threshold for a X ray request.
Nondisplaced fractures (< 1-2 mm displacement) with intact extensor mechanisms may be treated nonoperatively. The patient must be able to actively extend the elbow. In such cases, 7-10 days of casting usually suffice. The elbow can be placed at any degree of flexion. Displacement generally can be reduced by placing the elbow in more extension. *That was not the case with this patient.*
Dr Ray McGlone FRCCM
Short Reference Video
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