Nonoperative Management of Olecranon Fractures in Elderly Patients: A Systematic Review

Abstract

Background: Despite increased utilization of conservative measures for displaced olecranon fractures in elderly patients, in whom operative fixation may be complicated by coexisting comorbidities and declining bone quality, the noninferiority of nonoperative management has yet to be proven. The purpose of this study was to review nonoperative management of displaced olecranon fractures in the elderly patient population. Methods: A literature search of the PubMed database was performed using the term olecranon fracture. Papers included those with results for patients aged 65 years and older published between 1990 and 2018 in the English language. Data were pooled to analyze outcomes and complications of nonoperative management of olecranon fractures in the elderly patient population. Results: Four eligible studies combined for a total of 69 patients with 70 fractures with an average age of 83.8 years (71-95 years), female predominance of 88%, and a mean follow-up of 12.4 months who underwent nonoperative management of displaced olecranon fractures. While only 25% of fractures went on to radiographic union, the mean Disabilities of the Arm, Shoulder, and Hand score was 16.9 (0-59.6), the mean arc of motion was 138°, and 92% of patients achieved excellent results. One-quarter (26%) of the patients experienced complications: radial head subluxation (1), skin sore (1), degenerative arthropathy (1), pain on movement (2), click in movement of the elbow (5), and local pain (8). Conclusion: Displaced olecranon fractures in patients aged older than 70 years may be effectively managed with nonoperative measures to produce high satisfaction and functional range of motion.

Treatment of olecranon fractures in older individuals: a cross-sectional survey of surgeon treatment preferences

“…A recent systematic review of 4 studies including 69 patients with displaced olecranon fractures treated nonsurgically (mean age 84 years, mean follow-up 12 months, mean immobilization 12 days) reported low disability scores (mean Disabilities of the Arm, Shoulder and Hand 16.9), functional range of motion (138° flexion arc), 92% excellent results, and only 1 major complication. 1 Furthermore, one of the largest case series to date including patient-reported outcomes (n = 21 patients, average age = 89 years) reported minimal disability (mean QuickDASH 4.3 points) despite an average extension deficit of 15° and >80% nonunion rate. 21 …”

Is Tension Band Wire Fixation Superior to Plate Fixation for Simple Displaced Olecranon Fractures? A Randomized Trial With Median Follow-up of 7.5 Years

“…A possible alternative approach includes nonsurgical treatment for displaced olecranon fracture in older patients who have comorbidities because of concerns about a potentially higher risk of complications with operative treatment. In a recent systematic review, Alvara et al [2] concluded that nonoperative treatment of displaced olecranon fractures in patients older than 70 years in whom surgical treatment may be complicated by coexisting comorbidities is effective, with good functional results. Our results indicate that physicians should consider the increased potential risk of postoperative infection when surgically treating simple olecranon fractures in patients older than 85 years using plate and screws.…”