Paediatric olecranon fractures: a systematic review

Abstract

The optimal management and long-term outcomes of olecranon fractures in the paediatric population is not well understood. This systematic review aims to analyse the literature on the management of paediatric olecranon fractures and the long-term implications. A systematic review of several databases was conducted according to PRISMA guidelines. English-language studies evaluating the management of isolated paediatric olecranon fractures were included. Data extracted included demographics, classifications, conservative and operative treatment methods and outcomes. Fifteen articles fitting the inclusion criteria were included. There were 11 case series and four retrospective comparative series. The reported studies included 299 fractures in 280 patients. The mechanism of injury was predominantly low energy. Fractures displaced < 4 mm were treated non-operatively with almost universally good results, with the majority being treated with cast immobilization. Fractures displaced > 4 mm were commonly treated operatively with generally good results, with tension band wire and suture fixation being the most common treatment modalities. Weight > 50 kg was associated with failure of suture fixation. In those studies that reported olecranon fractures with associated elbow injuries (e.g. radial head fractures) outcomes were poorer. Forty-six fractures were in patients with osteogenesis imperfecta, who sustained a higher rate of re-fracture after removal of metalwork and contralateral olecranon fracture. Despite a relatively low evidence base pool of studies, the aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results, and support the operative treatment of fractures displaced ≥ 4 mm. Cite this article: EFORT Open Rev 2020;5:280-288. DOI: 10.1302/2058-5241.5.190082

Pediatric Olecranon Open Reduction and Internal Fixation Utilizing Arthrex Fibertape Cerclage Suture Technique: A Case Report

“…While olecranon fractures are relatively common in adults, they are presented less often in pediatric patients. In children, olecranon fractures only represent 4% of all elbow fractures, while the same fracture accounts for 10% of those in adults [3]. When treating these fractures, the surgeon must consider the following anatomic functions of the olecranon process.…”

“…Additionally, traditional fixation techniques present a common problem of diminished range of motion post-operatively. After traditional surgical procedures, doctors typically restrict patients from stretching exercises for up to 6-weeks and place the elbow in a sling, splint, or cast, which can all result in increased stiffness [3].…”

“…Olecranon fractures most commonly occur with direct impact to the elbow due to minimal protection from surrounding soft tissue or with indirect impact from forceful contraction of the triceps from a fall with an outstretched arm [2]. While minor non displaced olecranon fractures may be treated non-surgically, displaced fractures most likely require surgical intervention to restore normal anatomy, extensor mechanism, and range of motion [3,4]. Surgical treatments may vary depending on the type of fracture presented, which typically includes the use of metal plates, screws, wires and tension bands [3,4].…”

“…While minor non displaced olecranon fractures may be treated non-surgically, displaced fractures most likely require surgical intervention to restore normal anatomy, extensor mechanism, and range of motion [3,4]. Surgical treatments may vary depending on the type of fracture presented, which typically includes the use of metal plates, screws, wires and tension bands [3,4].…”

When Is an Isolated Olecranon Fracture Pathognomonic for Osteogenesis Imperfecta?

“…As such, it is less prone to fracture relative to surrounding structures, accounting for only 4% of all elbow fractures in children. 3 OI patients sustain olecranon fractures at a higher rate than non-OI patients, which has led some to conclude that isolated olecranon fractures are essentially pathognomonic for OI, specifically type-I. 2,[4][5][6][7] In addition, OI patients are significantly more likely to sustain a contralateral olecranon fracture, and within a relatively short period of time from their first fracture, compared with non-OI patients who sustain an olecranon fracture.…”