Nonoperative treatment of olecranon fractures in the elderly—a systematic review

Lenz, Maximilian; Wegmann, Kilian; Müller, Lars Peter; Hackl, Michael

doi:10.1007/s11678-018-0488-7

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…A recent systematic review of four included studies described similar findings to the present study with a mean MEPI socre of 95, a mean DASH score of 12, a mean flexion of 133° (106-140°), a mean extension lag of 15° (0-30°) and a mean VAS score of 1 (0-8) [20]. The authors conclude that the available literature supports a consideration of nonoperative treatment in the low-demanding elderly patients [20].…”

Section: Discussionsupporting

confidence: 87%

“…Therefore, it cannot be answered if the surgical group would also be similarly satisfied or show similar good results if treated conservatively. Similar to other studies [20], there might have been a high risk of selection bias regarding the choice of treatment in our study, as younger patients were rather treated surgically and older ones conservatively. Up to date, no relevant conclusions can be drawn when comparing conservative treatment with surgical treatment, especially in regard to more active elderly patients and additional research with randomized controlled multicenter trials involving larger sample sizes and longer follow-ups are necessary [20].…”

Section: Discussionsupporting

confidence: 76%

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Retrospective comparison of conservative treatment and surgery for widely displaced olecranon fractures in low-demanding geriatric patients

Kaiser

Stock

Benedikt

et al. 2021

Arch Orthop Trauma Surg

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Introduction The aim of this study was to evaluate the difference of the clinical outcome of elderly patients who were treated surgically or conservatively for a displaced olecranon fracture (Mayo type IIA or IIB). Patients and methods Patients above the age of 70 years who were treated surgically (n = 11) for a displaced Mayo type IIA and IIB olecranon fracture between July 2015 and February 2019 were retrospectively compared with patients who were treated conservatively (n = 6). The range of motion, elbow strength, grip strength, VAS, DASH, OES, MEPI and Broberg and Morrey scores were evaluated. Results The conservative group showed a non-union with a persistent fracture gap of 17 mm (SD 12 mm) at the articular rim and 31 mm (15 mm) at the dorsal rim while there was no case of non-union in the surgical group. The arch of motion was 120° in the conservative group and 136° in the surgical group. There was no obvious difference in elbow extension strength in comparison to the healthy contralateral side (p = 0.20; 88% group I/87% group II). There was no difference in the OES (p = 0.30; 42 (SD 7) vs. 45 (SD 5)) and MEPI score (p = 0.46; (SD 8) vs. 96 (SD 19)). The conservative group presented a slightly worse DASH [p = 0.10; 26 (SD 25) vs 7 (SD 14)] and a significantly worse Broberg and Morrey score (p = 0.02; 84(SD 9) vs. 95 (SD 7)). The conservative group presented one complication (ulnar nerve palsy), while the surgical group presented two cases (prolonged lymphedema; blocked forearm rotation due to screw length with consecutive revision surgery). Conclusion Widely displaced olecranon fractures can successfully be treated conservatively in low-demanding geriatric patients with a satisfactory outcome. Patient selection is essential as patients that are more active might benefit from surgical treatment. Yet, treatment risks and benefits need to be balanced carefully in regard to the patient`s demands and requests.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 76%

Retrospective comparison of conservative treatment and surgery for widely displaced olecranon fractures in low-demanding geriatric patients

Kaiser

Stock

Benedikt

et al. 2021

Arch Orthop Trauma Surg

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“…A recent systematic review of nonoperative management of olecranon fractures demonstrated that reasonable clinical outcomes can be achieved with nonoperative treatment modalities in patients older than 70 years. 12 The authors concluded that nonoperative management should be considered in this cohort of patients. One of the 4 studies included demonstrated a mean MEPS of 95.3 in 22 fractures followed up for at least 6 months in patients older than 75 years.…”

Section: Discussionmentioning

confidence: 95%

Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients

Aibinder¹,

Sims²,

Athwal³

et al. 2021

JSES International

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Background Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients. Methods A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months. The mean age at the time of injury was 79 ± 10 years. The average Charlson Comorbidity Index was 6.4 ± 2.6. Treatment modalities were at the discretion of the treating surgeon. A sling alone was used in 3 cases, an extension circumferential cast in 9, or a plaster or thermoplastic splint in 16. The mean period of immobilization was 5 ± 1 weeks. Outcomes included range of motion, ability to perform active overhead extension, as well as radiographic and functional outcomes. Results At final follow-up, the mean elbow range of motion for the cohort was from 28° ± 21° extension to 127° ± 15° flexion. Active overhead elbow extension against gravity was noted or documented in 24 (86%) patients. Two patients (7%) were unable to perform active extension. No pain was noted in 18 elbows, severe pain was present in 1 elbow, and the remainder reported mild occasional pain. All olecranon fractures in this cohort were displaced on the initial lateral radiograph. The mean displacement was 11 ± 7 mm. Nonunion at final radiographic outcome was observed in 23 (82%) elbows. Two (7%) patients developed skin complications related to posteriorly placed splints; one of which was severe. Discussion This study adds to the growing literature that supports nonoperative management of displaced olecranon fractures in elderly and medically unwell patients with low upper extremity demand. Patients can be counseled that they have a good chance of obtaining overhead extension, with minimal pain. Posteriorly based splints should not be used to minimize skin complications.

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“…With high complication rates in the use of tension band wiring, it remains unclear whether plate osteosynthesis would have a greater benefit, since only two patients received this procedure. Reviewing the existing studies regarding olecranon fractures highlights the need for RCTs in this field [18] .…”

Section: Olecranon Fracturesmentioning

confidence: 99%

Surgical enhancement of fracture healing – operative vs. nonoperative treatment

Baertl

Alt

Rupp

2021

Injury

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Although the success story of surgical fracture treatment led to a tremendous improvement of treatment outcome for certain fractures such as femur or tibia shaft fractures, the overall benefit of surgical versus conservative treatment remains controversial for several types of fractures. For this sake, we carried out a narrative review of high-level of evidence studies comparing treatment outcomes in fractures with controversial debates on the value of surgical therapy in clavicle, proximal humerus, olecranon, ankle, calcaneus and Jones fractures. We identified eight studies (Level-I and -2) with functional and quality of life outcomes in these fractures.Only in Jones fractures of the fifth metatarsal bone, bone healing and functional outcomes were significantly better after surgical compared to conservative treatment. In terms of patient-related quality of life, surgical treatment was not found to be superior compared to conservative treatment in all the above-mentioned fractures. In many trials, lower nonunion rates after surgical treatment were offset by complications due to the surgical procedure. Nonunion after conservative treatment often seemed to have only limited impact on functional results. However, the comparability of studies was limited due to age-differences between patients. Therefore, we emphasize the need for further investigations to determine which patient-related factors favor a conservative treatment approach and for whom surgery is the best option.

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Nonoperative treatment of olecranon fractures in the elderly—a systematic review

Cited by 11 publications

References 19 publications

Retrospective comparison of conservative treatment and surgery for widely displaced olecranon fractures in low-demanding geriatric patients

Retrospective comparison of conservative treatment and surgery for widely displaced olecranon fractures in low-demanding geriatric patients

Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients

Surgical enhancement of fracture healing – operative vs. nonoperative treatment

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