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Medical Journals Olecranon Fracture Posts

Fracture cast removed – after olecranon injury

SUCCESS! THE OLECRANON FRACTURE CAST IS REMOVED. I’m free to begin rehabilitation and physiotherapy!

However looking at how my arm moves, or doesn’t, now the fracture cast is off, the road to rehabiliation might be much harder than I thought!

Day 0 removal of the fracture cast – 2 weeks post op

For the last 2-3 days I’d been feeling tightness along my triceps, at the back of my arm. This was especially noticeable if I had not completed my physiotherapy exercises before lunch.

It seem daft, having not done the exercises you know will help you. Although occasionally you don’t want to wrestle with the pain, and doing to tricep stretch over my head, is really rather uncomfortable.

Fracture cast

Walking to fracture clinic

Fracture cast removal

I was a little anxious walking into the fracture clinic. Specifically what the X-ray would show, and what that would enable me to do? From the point of view of getting mobility back, I wanted out of the fracture cast ASAP, but I also appreciate that being without a fracture cast in the third week post op means taking extra care as the new bone is still soft. Yes the wires will stop the fracture from moving to any significant degree, but I might still be slightly susceptible to shear stresses across the fracture should I fall, or the the elbow a really hard jolt. Not that I was worried

Initially the fracture cast was removed, so the consultant could inspect the arm, and assess the movement. Thankfully he appeared happy with the small amount of movement possible – I was shocked, it felt like my arm was wrapped in thick plastic and wouldn’t move!

Radiology

To confirm what needed to happen with the fracture cast and establish the progress of the fracture healing an X-ray was required. Allowing the consultant to see what the fracture lines looked like. Thankfully, unlike my first series of X-rays, these were much less painful. Although rather stiff!

Olecranon fracture cast

The radiology plate used to look at the progress of my olecranon fracture

Even though I’ve already been examined by the consultant, who had reassured that moving the arm was safe. The the wires would hold the fracture and the cast was only for protection. I’d only been out of plaster 5 minutes, and I’d become VERY accustomed to the fracture cast. Thus whilst I sat having my X-rays taken, I remained VERY protective of the elbow. This might explain why I’m still holding it in the same position as when in the fracture cast!

Olecranon fracture cast

Fracture callus

Xray Results

Looking at the X-ray, above the consultant was happy with the progress, the think dark grey band, shown clearly in the image below is the actual callus. The new, soft bone that has filled in the fracture site. Which will hopefully remodel over the next few months from cartilaginous callus, to strong bony callus, before finally being remodelling completely back into bone.

Bone is an amazing tissue in this sense. Assuming correct position and no complications, bone is the only tissue in the body that can heal without scarring.

Olecranon fracture cast

Fracture forces stress point

On both X-rays, there are two pieces of equipment: K-Wires, the bits of string-like metal, and two long straight pins. The k-wires work as a tension-band system. When the arm is extended/straightened, the triceps pulls on the tip of the olecranon (The nub, where the fracture is). However this force is instead transmitted through the K-wires, to pull on the bone after the K-wires, which is circled in orange

Looking at the X-rays, the fracture is healing well! Best of all, the consultant says the fracture cast is to stay off.

Something else that has shown up on the X-rays is the possibility of a microfracture where the K-wires went in. Also in the orange circle. This may have been the reason I was experiencing a lot of pain in the centre of the arm, away from the fracture site.

The upshot of these little fractures is that I will now have to be extra careful when doing physiotherapy stretches

Range of movement

With the consultant happy about the fracture, the movement was assessed again.

As I’d been using a PowerBall over the last weeks my wrist had been well maintained. Unfortunately the same couldn’t be said for the elbow. Even after the reassurance that I would not be able to damage anything, it wouldn’t move much. My elbow had been held at approximately 90 degress for the last week, I couldn’t really bend it more than 100 degrees. As for extension, I wasn’t able to get past 30 degrees.

fracture cast

Range of normal elbow movement

Fracture cast

Best extension possible

Just so we are clear, not being able to move the arm is one of the oddest sensations I’ve ever had. You try and flex your arm, it starts off moving, and then just stops. It’s like something has jammed in the mechanism and is preventing it closing any further. A similar effect was seen trying to straighten the arm. As though an invisible force just says “no; that’s far enough”

The consultant advised me to try and “let the arm hang, to let gravity start to straighten it whilst walking”. A good plan by all accounts. But what wasn’t explained was that at this stage was that your arm is going to “set” in any position after a short period of time.

A little like sitting with your legs crossed under you on the couch for 30mins. A you come to move, the legs are a little stiff and slow. The same thing would happen with my arm, but in 10minutes, with 10 times the stiffness. Not that this really mattered considerably as I wasn’t exactly wanting to start jumping around.

That was a little concerning, but I was advised the Physio would get that sorted and the arm moving over the next few weeks

Stitch removal

The final stop before leaving fracture clinic was to have the stitches removed. Removed – well pulled out is a better description!

Thankfully, the skin across the operation wound is completely numb. This was particularly useful, as the stitches didn’t want to come away, so I just explained to the nurse she could be a little more forceful – AS LONG AS THE ARM DOESNT MOVE. That certainly sped things used for both of us, but I wonder how long that’s going to be numb for. It’s an area of at least 5-10cm square. Just feels like dead, numb flesh. A little disconcerting, but it will take careful cleaning of the arm a little easier.

Fracture cast

Stitches removed

Although I was advised not to get it wet until tomorrow. Again the worries about infection, this time going down the tracts where the stitches were removed.

With the stitches removed, I was off home, to carry on eating; and to return to following day at 8am for the first physiotherapy session!

 At home update

Upon coming home I was astonished to see what my arm looked like, it didn’t look, and certainly didn’t move, like my arm. The really worrying part, in spite of having eaten like a horse over the past two weeks, was I’d dropped from 74kg in weight to 70.kg!

To be clear, I’m not for a second suggesting a new “Fracture weightloss diet”. Particularly so as my fat mass has remained constant, suggesting the weight loss has been from muscle as much as fat.

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Comments

  1. Hi. I have had the same same surgery but my op was delayed for 2 weeks and had a cast on 3 weeks post op. Been out of my cast for nearly a week now and i only have about 10° of movement which seems quite worrying. My elbow is super tight. Is this normal?

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  4. Hi,

    I find myself, 4 months after the accident, in the situation where the metal work is backing out of my elbow. The x-ray last week confirmed it and I am scheduled for an op to have it removed. I just wanted to get an understanding from anyone who can help – how long did you have to wait to have the op? I have to wait 5 weeks so am worried that the metal work could continue backing out of my arm until one day it actually pops through the skin! Eek, could that happen? I have also noticed that my hand is really stiff in the morning and have shoulder ache which I am guessing is all related but are these normal symptoms? My range of movement is really bad, almost at the stage it was post op and it had been almost back to normal! I stopped using the powerball a while ago but am starting to think it might help whilst waiting for the op or maybe do more damage?!

    So many questions, I know, but I am hoping for a bit of re-assurance/guidance from anyone who has been where I am at the moment.

    Thank you.

    Natasha

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  5. Hi James,

    I need your advice again – can I private message you please?

    Natasha

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  6. Thanks for the quick reply James.

    I have spent the past week trying to find answers to my questions with little success. Your blog is fantastic and really making a difference to me.

    I am anxious about having the cast removed as it seems like the hard work is about to begin but I am going to do everything the physio recommends and see it as an opportunity to improve my diet and fitness levels.

    Thanks again.

    Natasha

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  7. Hi, I hope you can help. I broke my ulna bone, clear break, near the olecron. Metal wires and screws put in and I am currently in a cast. It should come off, all being well, in a few days. However, and I know this is gross, I have felt a liquid sensation under the cast and it feels like a screw near my elbow. I will call the hospital tomorrow but just wondered, did you experience anything like this? I hope it isn’t a screw I can feel, it could be a stitch but it does hurt.

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    • The screw sensation could be anything – I would call the hospital, but as long as there are no pins and needles or swelling to the hand you should be ok

      As for the liquid feeling I had the same, but when the cast came off there was a bit of dried ooze, but nothing else

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  8. Iv just removed my cast today.. but im not being able to do much movements with my wrist .. is it normal?

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    • Absolutely. Everything gets stiff when it’s immobile. Have a look at a powerball to get things moving a day – It was one of the first reviews I did when I set up the site

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  9. Has the k wire caused you any pain or discomfort?

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    • Yvonne Moore - July 13, 2016 at 6:39 am - Reply

      Hi Jen
      Had now 13 months of problems since my olecranon fracture
      One wire protruded within 10 weeks and was removed
      The rest then slipped with the rod puncturing the bone muscle tendon and ulnar nerve
      I had emergency surgery in February to remove the wires as I had lost the function of my right hand
      My orthopods refused to listen to me insisting the wires stay for a year but my lovely shoulder surgeon intervened behind my trauma surgeons back to get the removal
      What should have been a quick op with me awake with a nerve block took two and a half hours as a lot of bone had been deposited around the wire
      This was February
      I still have extreme pain and stiffness with this new bone pressing on nerves
      My function is rubbish and I still cannot cook even an omlette

      If you get to the point where the wires bother you but the fracture has healed get the wires out asap!!

      It is better to do that then take things slowly than get all this ossified extra bone bogging the wires down – in my humble opinion!

      This fracture has aged me a decade!

      Make sure you optimise your nutrition for calcium vitamin d and protein etc as the fracture takes a lot out of your body

      Hope this helps

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    • Yes which is why I had mind removed as soon as I could. Also greatly improved my range of movement.

      Now I barely ever know that I broke it

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  10. Yvonne Moore - June 26, 2015 at 6:59 am - Reply

    So useful
    Broke my right olecranon last week and got surgery on Monday
    Feeling sorry for myself but your post has enlightened me more than the hospital did
    Hope you are fully recovered

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    • I’ve got my next op on July 15th. I was actually very frightened going into the surgery if I’m honest. However there was nothing to worry about at all. I’m really calm about the next op.

      I’m 97% recovered, it’s now just the metal work restricting the movement. Hence the next op. Any questions, problems or concerns drop me an email. [email protected]

      How did you fracture it?

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