Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Ulna, extraarticular, avulsion of triceps insertion

back to skeleton

Glossary

General considerations

A small piece of olecranon nearly always indicates a triceps avulsion. Some triceps avulsions are partial, and people have reasonable elbow extension strength with nonoperative treatment. Patients with notable weakness - those that cannot extend against gravity in particular - should consider operative repair.

Nonoperative
Indication summary Skill Equipment
Minimal displacement (< 2 mm). Active elbow extension. Immobilization unnecessary. Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • Partial triceps avulsion with good residual extension strength
  • Infirm, less active patients that can function without elbow extension strength (eg demented persons dependent on others for basic tasks such as bathing and eating)

Contraindications

  • Preference for strong elbow extension
  • Polytrauma

Advantages

  • Avoid medical and surgical risks

Disadvantages

  • Difficult to reconstruct later if unsatisfied with elbow extension strength
Tricepts reinsertion
Indication summary Skill Equipment
Triceps avulsion with unacceptable weakness Some specialized surgical experience Basic equipment only

Further indications

  • Displacement of more than 2 mm

Contraindications

  • Infirm patient (high anesthetic risk)
  • Infected or abraded skin. Let the skin heal first
  • Functionally low demand patient

Advantages

  • Restoration of extensor mechanism / optimal elbow extension strength

Disadvantages

  • Potential for prominent suture or wire
  • Operative complications (anesthesia, infection, skin necrosis)
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-04-30