Review Question - QID 3537

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Olecranon Fractures Treatment Nonoperative QID: 3537 (OBQ11.114)

QID 3537 (Type "3537" in App Search)

An 82-year-old nursing home resident falls onto his elbow while rising from a seated position. He has pain and swelling at the elbow without evidence of instability. His radiographs show a comminuted displaced olecranon fracture involving 25% of the articular surface with global osteopenia. Which of the following treatment options has a low risk of complications and a high likelihood of a functional elbow outcome?

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Cast immobilization in 45 degrees of flexion for 8 weeks

12%

699/5777

Closed reduction and percutaneous pinning

97/5777

ORIF with a tension band construct

292/5777

ORIF with a locking plate

34%

1988/5777

Cast immobilization in 90 degrees flexion

46%

2662/5777

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The patient in the scenario is a low-demand, elderly patient with a comminuted olecranon fracture. Recent studies have demonstrated good outcomes with non-operative treatment of olecranon fractures in this patient population.

Hak (jaos'00) 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 an option in the case of severely comminuted, osteoporotic patients with a fracture involving <50% of the joint surface.

Duckworth (jbjs'14) performed a single center retrospective review of low-demand patients with displaced olecranon fractures managed non-operatively with a short duration of immobilization followed by range of motion to tolerance. The authors found good short and long-term results with this treatment with patients experiencing minimal discomfort or loss of motion at long-term follow up.

Incorrect answers:
Answer 1: Cast immobilization in 45-90 degrees of flexion is advocated for non-displaced fractures. Furthermore, casting for 8 weeks is not indicated in nonoperative care of olecranon fractures secondary to the development of stiffness.
Answers 2-4: Not the treatment in low demand patients with severe comminution and osteoporosis.