Non-surgical functional treatment for displaced olecranon fractures in the elderly

Abstract

We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment. We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction.

Displaced olecranon fractures in the elderly: outcomes after non-operative treatment – a narrative review

“…Initial immobilization was maintained with an above-elbow cast at a flexion of 90° for a mean time of 5 days (range, 4–7) and subsequently a sling was applied, encouraging all patients for early active ROM of the elbow with no formal rehabilitation. 3 …”

“… 10 , 12 , 22 , 23 There have been a limited number of studies reporting functional results and patients’ satisfaction after non-operative treatment of displaced olecranon fractures in the elderly ( Table 1 ). However, most of the studies are retrospective case series with a total of 83 patients, 3 , 16 , 19 with only two prospective studies 24 , 25 with a total of 22 patients.…”

“…Fractures of the olecranon account for about 10% of upper extremity fractures, 1 , 2 with the majority occurring in elderly patients. 1 , 3 Usually these fractures are displaced (Mayo type II and III), 4 due to distraction of the triceps tendon. 1 , 2 Operative treatment, in order to restore articular congruity, has been the standard choice of care.…”

“…The incidence of olecranon fractures in the elderly is constantly increasing and, given the potential complications of operative treatment, attention has been recently drawn to the non-operative management of these fractures, although the results are still controversial. 3 , 16 – 19 The aim of this study is to review the functional scores, patients’ satisfaction and complications after non-operative treatment of displaced olecranon fractures in the elderly population.…”

SOFIE: Surgery for Olecranon Fractures in the Elderly: a randomised controlled trial of operative versus non-operative treatment

“…Further to this high complication rate, there is recent evidence from case series that non-operative management of displaced olecranon fractures is a reasonable option in elderly patients, with comparable outcomes without the risk of anaesthetic and surgical complications [ 10 , 17 – 19 ].…”