Title : Management of olecranon fractures in the elderly – Literature review and proposal of a treatment algorithm
Abstract:
Olecranon fractures in the elderly pose unique challenges, especially the displaced fractures due to associated comorbidities, poor tissue quality, higher complication risks and the need for implant removal. Treatment options range from non-operative to various surgical fixation techniques. Currently there is no consensus on the treatment of these fractures in the elderly. We reviewed the literature, according to PRISMA guidelines, using PubMed, Wiley Online Cochrane Library, Scopus and Embase. Papers looking at patients older than 60 years of age and all modalities of treatment were included, and study titles and abstracts were studied.
We found 14 studies which fulfilled our criteria, totaling 271 patients. Of these patients, 112 were treated non-operatively, 29 within limited fixation, 105 with metallic tension band wire fixation and 25 were operated with plate fixation. We found that non-operative as well as limited fixation provided satisfactory results in most patients, depending on the type of fracture. Despite various treatment options available, the decision to treat should therefore be individualized to various factors such as – fracture stability, quality of bone & soft tissues as well as functional demand of the patient. Hence, we recommend a treatment protocol for treating different types of olecranon fractures in the elderly population based on the above factors.
