Prospective randomised trial of non-operativeversusoperative management of olecranon fractures in the elderly

Abstract

These data further support the role of primary non-operative management of isolated displaced fractures of the olecranon in the elderly. However, the non-inferiority of non-operative management cannot be proved as the trial was stopped prematurely. Cite this article: 2017;99-B:964-72.

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

“…Only one patient in the conservative group developed a complication and had to be operatively revised owing to a concomitant radial head fracture and subsequent infection. The trial was stopped prematurely after the recruitment of 19 patients because of the high complication rate in the operative treatment cohort [3].…”

“…While nonunion is a common sequela of nonoperative treatment, it does not seem to impair low-demand patients in activities of daily living according to the available literature. Given the significantly lower complication rates when compared with operative treatment as described by Duckworthet al, nonoperative treatment of olecranon fractures should be strongly considered in these patients [3]. On the other hand, operative treatment seems to be more reliable in restoring ROM and extension strength, and may thus still be preferred over conservative therapy in the active elderly patient.…”

“…The fact that fracture morphology was not taken into account by any of the included studies has to be considered a noteworthy confounding factor. Small proximal avulsion fractures, which are commonly seen in elderly patients with reduced quality of bone, are difficult to address by either TBW or plate fixation and may explain the high rate of secondary displacement following ORIF in the RCT published by Duckworth et al [3]. Especially in these patients, conservative treatment may be propagated in the future.…”

“…Complication rates after operative treatment are considerably increased in the elderly patient [3,4]. As a result, nonoperative treatment of olecranon fractures in the elderly has been advocated in recent years by several authors [3,5,8,18]. In low-demand elderly patients in particular, nonoperative therapy may lead to satisfactory results, while active patients may still benefit from surgery.…”

Long-term outcomes after different types of Horne and Tanzer olecranon fractures

“…No study has to our knowledge evaluated if the favorable long-term outcome accounts for all subtypes of olecranon fractures. Most shortterm studies have only evaluated if the outcome differs after different type of surgeries [4][5][6][7][8][9][10][11][12][13][14]. On such study inferred that type of surgery are of more importance for the outcome than type of fracture [16], another study supporting this view when reporting no differences when comparing 78 consecutive patients with Mayo type IIA and IIB fractures [17].…”