The patient in the scenario is a low-demand, osteoporotic, elderly patient with a comminuted olecranon fracture. The treatment of choice in this subset of patients with this fracture pattern is fragment excision and triceps advancement.
Hak et al reviewed the treatment of olecranon fractures, recommending ORIF for displaced intra-articular fractures, either via tension band wiring or plate osteosynthesis based on fracture pattern and associated ligamentous disruption. For elderly, low-demand, osteoporotic patients, triceps advancement and fragment excision is advocated in the case of severely comminuted, osteoporotic patients with a fracture involving <50% of the joint surface.
The reference by Morrey is a comprehensive review of fractures and fracture-dislocations about the elbow.
Answer 1: Cast immobilization in 45-90 degrees of flexion is advocated for non-displaced fractures.
Answer 2: Not the treatment in cases of severe comminution and osteoporosis.
Answer 3: Not the treatment in cases of severe comminution and osteoporosis.
Answer 4: Not the best option for a low-demand patient with severe comminution and minimal joint surface involvement.
Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000 Jul-Aug;8(4):266-75.
PMID:10951115 (Link to Abstract)
Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995;44:175-85.
PMID:7797857 (Link to Abstract)