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Nonunion of Olecranon Stress Fractures in Adolescent Baseball Pitchers

A Case Series of 5 Athletes

Arthur C. Rettig, MD^*,, Todd R. Wurth, MD and Paul Mieling, MS, OTR, ATC/L

From the Methodist Sports Medicine Center, Indianapolis, Indiana, and The Bone and Joint Clinic, Franklin, Tennessee

^* Address correspondence to Arthur C. Rettig, MD, Methodist Sports Medicine Center, Department of Research and Education, 201 Pennsylvania Parkway, Suite 235, Indianapolis, IN 46280 (e-mail: phunker{at}methodistsports.com).

Background: Adolescent athletes participating in overhead throwing sports suffer a variety of overuse elbow injuries, many of which have been well described in the literature. Nonunion stress fractures of the olecranon across the epiphyseal plate, however, have received little attention.

Purpose: To describe this unusual clinical entity in the differential diagnosis of the adolescent athlete with elbow pain and to demonstrate that operative treatment is an effective means of quickly and safely returning the patient to sporting activities.

Study Design: Case series; Level of evidence, 4.

Methods: Five adolescent baseball pitchers (mean age, 15 years) who suffered chronic elbow pain and who were diagnosed with olecranon epiphyseal stress fracture nonunions were treated with open reduction and internal fixation using a 7.0 cancellous screw and washer with or without 18-gauge tension banding.

Results: Return to preoperative range of motion was achieved at a mean of 8.6 weeks (range, 3.4–16.6 weeks). Patients were clinically asymptomatic at a mean of 11 weeks (range, 7.7–13.6 weeks) after surgery. Radiographic evidence of stress fracture union was achieved at a mean of 15.4 weeks (range, 6.1–33 weeks), including 1 patient with a delayed union according to radiographs, which healed at 33 weeks. Patients were started on a light strengthening program at 5 to 7 weeks and a throwing progression program at 15.6 weeks (range, 6.4–28.1 weeks). All 5 patients were able to return to their previous level of activities, with a mean return time of 29.4 weeks (range, 18.9–40.4 weeks).

Conclusion: Surgical management of olecranon apophysis stress fractures provided excellent results with minimal complications in this series of 5 consecutive cases.

Key Words: elbow • stress fracture • adolescent • baseball