Evaluation of the association between olecranon fracture and radial head subluxation or annular ligament displacement in children

Abstract

Olecranon fractures are seen substantially more often in children than in adult and are potentially occult in nature. We noticed this fracture pattern in two cases of delayed Monteggia fracture. Our study purpose was to confirm whether olecranon fracture is associated with radial head subluxation or annular ligamentous displacement in children. In addition, we have developed an effective and simple approach to avoid serious treatment-related complications as much as possible. Forty-eight pediatric patients with olecranon fracture and normal radiocapitellar alignment on radiography were enrolled. All patients' fingers, forearms and elbows were examined carefully, and treated with a modified radial head reduction approach and then cast immobilization. MRI of the affected elbow was performed in 16 symptomatic patients. Overall, 70.83% of patients had a positive clinical finding of radial head subluxation. These symptomatic patients presented with similar clinical findings that typically included painful finger movement actively or passively and movement limitation of forearm and elbow. MRI showed that annular ligaments were interposed and trapped in the radiohumeral joint. In 34 symptomatic patients, 91.18% of them achieved fair radial head reduction during the first reduction attempt. Herein, 95.85 and 100% of patients reported excellent and satisfactory outcomes, respectively. Radial head subluxation occurred in most children with an olecranon fracture. We highly suggest performing a careful physical examination to identify this fracture pattern. Early reduction of the radial head with the modified approach may be a simple and primary option for emergency room doctors.