Sat., 10/6/12 Upper Extremity Injuries, PAPER #84, 10:33 am OTA-2012
Nonoperative Management of Displaced Olecranon Fractures
Andrew D. Duckworth, MBChC,BSc (Hons); Kate E. Bugler; Nicholas D. Clement, MBBS;
Charles M. Court-Brown, MD; Margaret M. McQueen, MD;
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh,
Edinburgh, Scotland, United Kingdom
Purpose: Recent literature has documented the increasing mean age of olecranon fractures, with many now considering it a fragility fracture. Given this, it is now recognized that work is required to determine if the surgical treatment for displaced olecranon fractures in lower-demand patients, and/or patients with multiple comorbidities, provides a significant benefit over nonoperative management. The aim of this study was to document both the short- and long-term outcome of isolated displaced olecranon fractures treated with primary nonoperative intervention.
Methods: We identified from our prospective trauma database all patients who were managed nonoperatively for a displaced olecranon fracture over a 13-year period. Inclusion criteria included all fractures of the olecranon (OTA 21-B1.1) with >2 mm displacement of the articular surface. Comminuted fractures were included. Patients were excluded if there was inadequate data or if they had sustained an open fracture or a fracture dislocation. Demographic data, fracture classification (OTA and Mayo), management, complications, and subsequent surgeries were recorded. The primary short-term outcome measure was the Broberg and Morrey elbow score. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) and Oxford Elbow Score.
Results: There were 43 patients in the study cohort with a mean age of 76 years (range, 40-98) and 65% (n = 28) were female. A low-energy fall from standing height accounted for 84% of all injuries. One or more significant comorbidities was documented in 88% (n = 38) of patients. Mayo type 2A fractures were the most common fracture type (n = 33, 76.7%), with 10 patients noted to have fracture comminution (n = 10, 23.3%). A collar and cuff followed by active mobilization was used in 15 patients (35%), with an above-elbow plaster cast with the elbow in 60° to 90° of flexion used in 28 cases (65%). At a mean short-term follow-up of 4 months (range, 1.5-10), the mean flexion arc was 109° (range, 50°-135°) and the mean Broberg and Morrey score was 83 (range, 48-100), with 73% achieving an excellent or good short-term outcome. No patients underwent further surgery for a symptomatic nonunion. Long-term follow-up was available in 53% of patients (n = 21), with the remainder deceased. At a mean of 6 years (range, 2-15) after injury, the mean DASH score was 2.9 (range, 0-33.9), the mean Oxford Elbow Score was 47 (range, 42-48), and overall patient satisfaction was 91% (n = 21).
Conclusion: To our knowledge, this is the largest series in the literature documenting both the short- and long-term outcome following nonoperative management for a displaced fracture of the olecranon. From our data, we would suggest that nonoperative management of displaced olecranon fractures in lower-demand elderly patients with multiple comorbidities produces a good or excellent long-term patient-reported outcome. Further work is required to directly compare operative and nonoperative management in this patient group.
Alphabetical Disclosure Listing (808K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.