Repeat dosing per operative timing and local protocol
Severe cephalosporin allergy
Clindamycin IV 900 mg
Gross contamination or farm injury concern
Add gentamicin IV 5 mg/kg per protocol
Tetanus prophylaxis
Unknown or incomplete immunization
Tdap
Tetanus immune globulin per protocol
Up to date immunization
Tdap if due by schedule
Wound care
Sterile moist dressing
No aggressive ED debridement
Irrigation when heavily contaminated if it does not delay antibiotics and transfer
DVT prophylaxis when relevant
Upper extremity immobilization
Routine pharmacologic prophylaxis not typical for isolated ambulatory upper extremity injuries
Elevated risk scenarios
Prolonged immobility
Active malignancy
Prior VTE
Concurrent lower limb immobilization
Anticoagulation decisions aligned with local protocol and surgical plan
Special Populations
Pregnancy
Maternal priorities
Pain control with pregnancy safe options
Acetaminophen preferred
NSAIDs avoidance in later gestation per obstetric guidance
Imaging safety
Elbow radiographs with shielding when feasible
CT only when management depends on detailed characterization
Disposition considerations
Lower threshold for observation if trauma mechanism high energy
Obstetric consultation when abdominal trauma or concerning symptoms
Geriatric
Fragility context
Low energy fall mechanism common
Osteoporosis risk and secondary prevention referral
Medication safety
Opioid delirium risk
Lower dose titration
NSAID renal and GI risk
Disposition threshold
Higher admission threshold with poor supports or inability to self care
Pediatrics
Growth plate considerations
Apophyseal injury patterns near triceps insertion
Subtle radiographic findings
Non accidental trauma consideration
Mechanism inconsistency with developmental stage
Additional injuries on exam
Immobilization and follow up
Weight based analgesia dosing
Early orthopedic follow up for displaced patterns
Background
Epidemiology
Occurrence patterns
Adult olecranon fractures common in falls and direct blows
Older adults increased incidence from low energy falls
Risk factors
Osteoporosis
Seizure related falls
High energy trauma in younger adults
Pathophysiology
Anatomy and biomechanics
Olecranon as proximal ulna articular surface
Triceps insertion creating extension force
Posterior skin vulnerability over olecranon
Pattern formation
Direct impact producing comminution
Triceps avulsion producing transverse fracture
Complications mechanisms
Loss of extensor mechanism with displacement
Elbow stiffness from immobilization and intra articular injury
Post traumatic arthritis risk with articular incongruity
Ulnar nerve irritation from swelling or hardware
Therapeutic Considerations
Nonoperative rationale
Nondisplaced fracture stability
Intact active extension
Low demand patients selective pathway
Operative rationale
Displaced intra articular fracture
Extensor mechanism disruption
Elbow instability patterns
Immobilization timing balance
Early motion reduces stiffness risk
Excess early flexion may increase displacement risk
Evidence framing
Shared decision making for elderly low demand displaced fractures when surgical risk high
Patient Discharge Instructions
Copy discharge instructions
Splint care
Keep splint clean and dry
Do not insert objects into splint
Check fingers for swelling and color change
Swelling control
Elevation above heart as much as possible for 48 to 72 hours
Ice over splint area in short intervals if safe and dry
Activity restriction
No lifting with injured arm
Sling for comfort
Finger range of motion exercises as tolerated
Pain plan
Acetaminophen scheduled use if safe
NSAID use if safe and no contraindications
Opioid only for breakthrough pain with sedation precautions
Return to ED now
Increasing pain not controlled
New numbness or weakness in hand
Fingers cold pale or blue
Increasing tightness or swelling in splint
Splint too tight or causing pressure sores
Fever
Wound drainage or foul odor
Follow up
Orthopedics appointment within recommended interval
Repeat imaging at follow up as directed
References
Clinical guidelines and evidence sources
Open fracture management references
BOAST guidance for open fractures
Early antibiotics
Early orthopedic involvement
ATLS principles for extremity trauma triage
Life threats before limb threats
Procedural sedation references
ACEP clinical policy for procedural sedation in the ED
Monitoring standards
Airway readiness
Orthopedic references
AAOS patient and clinician resources for upper extremity fractures
Operative vs nonoperative principles
Standard orthopedic classification references
Mayo classification for olecranon fractures
AO OTA fracture classification
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.