PEDIATRIC OLECRANON FRACTURES

Pediatric olecranon fractures account for approximately 4% of all pediatric elbow fractures. However, in 20% of cases, concomitant injuries may complicate the clinical picture. The thick periosteum and the largely cartilaginous nature of the olecranon region in children contribute to a lower incidence and reduced severity of these fractures compared to adults. Fractures typically occur as a result of hyperextension trauma or direct impact to the elbow in a flexed position. Classification is generally based on either the location of the fracture (apophyseal or metaphyseal) or the mechanism of injury (flexion, extension, or shear). Apophyseal fractures are rare and are most commonly observed near the closure of the growth plates. These injuries range from mild apophysitis to complete avulsion frac-tures. In young athletes, repetitive stress on the olecranon apophysis can result in stress fractures. In contrast, metaphyseal fractures are more common, typically occurring in children aged 5-10 years. The flexion-type injury is the most frequently encountered pattern, often leading to posterior displacement due to the strong traction exerted by the triceps muscle. Extension-type injuries, on the other hand, are frequently associated with longitudinal greenstick fractures. Shear-type fractures are less common and are characterized by anterior displacement of the distal fragment following a direct impact on the posterior surface. Clinically, pain, tenderness, and an inability to fully extend the elbow are the pre-dominant symptoms. Diagnosis is usually made through radiographic evaluation; however, in younger children with incomplete ossification, radiographic identification of the fracture can be challenging. Non-displaced or minimally displaced fractures are typically managed conservatively using casting or splinting. In cases with significant displacement, surgical intervention is required, particularly when the articular step-off exceeds 2-4 mm, as this is considered a critical threshold for operative manage-ment. Surgical treatment options include open reduction and internal fixation using pinning, tension band wiring, sutures, or screws. Despite the use of fixation materials that extend into the growth plate, growth disturbances are rarely reported, likely because these fractures occur near the closure of the growth plate. With appropriate treatment, favorable outcomes are generally achieved. However, com-plications such as nonunion, growth plate disturbances, or loss of reduction may still occur. Accurate evaluation, proper classification, and the selection of an optimal treatment strategy are crucial for ensuring functional recovery in pediatric olecranon fractures.