Background: For displaced olecranon fractures, surgery is the standard of care in young adults but remains controversial in patients aged 75 years or over. The objective of this study was to assess the functional and radiological outcomes and to describe the complications of surgical treatment in this older population.
Hypothesis: Surgery is the optimal treatment for displaced olecranon fractures in patients aged 75 years or over.
Materials And Methods: We retrospectively reviewed the files of patients who were 75 years of age or older when they underwent surgery for displaced olecranon fractures at our centre between January 2013 and December 2017. Functional and radiological outcomes were assessed at radiological fracture healing or at last follow-up.
Results: We included 29 patients with 30 fractures. Mean age was 82 years (range, 75-93 years). All 30 fractures were Mayo II or III, A or B. Tension-band wiring was used for 21 fractures, locked-plate fixation for 7 fractures, and double-plate fixation for 2 fractures. The mean Mayo Elbow Performance Score was 82.5 (range, 45-100). Complications occurred for 11 (37%) fractures, and the material was removed for 11 (37%) fractures.
Discussion: The complications resulted from a mismatch between fracture type, bone quality, and the internal fixation material. Compared to tension-band wiring, plate fixation was associated with more complications, many of which required removal of the material. Tension-band wiring was not sufficient for proximal fractures and type III B fractures, for which lacing is an alternative. Conservative functional treatment remains a wise option for type II olecranon fractures in these elderly patients. Surgery is required, however, in patients with type III fractures (fracture-dislocations).
Level Of Evidence: IV, retrospective, single-centre, observational cohort study.
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Article Synopsis
- The ulnar nerve is often affected by complex elbow dislocations due to its unique anatomy, leading to variable treatment outcomes and pain among patients.
- A study involving 44 patients revealed that those who had ulnar nerve transposition during surgery experienced more incidents of neuropathy, although their symptoms were less severe but lasted longer compared to those who did not have the procedure.
- The findings suggest that routine transposition of the ulnar nerve may not be necessary in these cases, but further research with larger sample sizes is needed to confirm these conclusions.
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