Ulnar fractures: patient examination

Clinically, patients affected with a fracture of the olecranon will present with acute onset, severe lameness. They will usually be grade 4-5/5 lame. The degree of soft-tissue swelling in the area will vary depending on the inciting trauma and secondary fracture displacement. When there is displacement, the patient will usually present with a dropped elbow stance and be unable to extend the elbow and carpus. This is particularly common in type 1b fractures in foals.

The differential diagnosis for a patient that presents with a dropped elbow stance include fractures of the humerus as well as radial nerve injuries. In addition, patients with fractures of the scapular neck region may assume a similar stance. It is often possible to differentiate humeral and olecranon fractures on clinical examination. In some instances, the olecranon fracture can be palpated. The location and character of the soft-tissue swelling can also help differentiate a humeral from an olecranon fracture. Humeral fractures, especially those affecting the diaphyseal region are usually accompanied by an apparent swelling of the brachial region when viewed from the front of the patient (left).

Diagnostic images are best obtained in the standing patient by directing the beam from medial to lateral and slightly cranial to caudal with the leg held in extension by an assistant.
A cranial to caudal projection is required to rule out additional injury, especially of the radius.