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

Abstract

Background: Most olecranon fractures are treated with open reduction and internal fixation (ORIF) leading largely to good clinical results. However, some studies have reported increased complication rates in the elderly. Therefore, nonoperative treatment of olecranon fractures in the elderly patient has been investigated by several authors in recent years. The aim of this study was to evaluate the clinical results of nonoperative treatment of olecranon fractures in elderly patients by means of a systematic review of literature. Methods: We systematically reviewed the literature on nonoperative treatment of olecranon fractures in patients with a minimum age of 70 years. Primary outcome parameters investigated were the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome parameters were pain, range of motion (ROM), development of nonunion, and complications. Results: Two retrospective case series, one prospective case study, and one randomized controlled trial were included (n = 70). The mean follow-up was 10.7 months. All studies reported good clinical results for nonoperative treatment of olecranon fractures. The mean MEPI was 95.1 and the mean DASH score was 12.3. Mean flexion of the elbow was 133° (106–140°) with a mean lag of extension of 15°. The operative cohort showed a significantly increased complication rate. Conclusion: Nonoperative treatment of olecranon fractures seems to provide acceptable clinical results in the elderly. However, the literature on the treatment of olecranon fractures in elderly patients is limited. While ORIF remains the gold standard, nonoperative treatment should be considered in the elderly patient in light of the recently published literature.