Treatment of Olecranon Fractures in the Elderly

Operative or Non-Operative Treatment of Displaced Fractures of the Elderly - a Nordic Multicenter Randomized Trial

Operative treatment, with tension band wiring or plate fixation, will be compared with non-operative treatment of displaced olecranon fractures (Mayo classification 2A and 2B) in patients 75 years or older.

Displaced olecranon fractures disrupt the extensor mechanism of the elbow and operative treatment is therefore usually recommended. Tension band wiring (TBW) and plate fixation (PF) are the most common surgical treatment options. Both methods are associated with high complication and reoperation rates, especially in elderly patients. Only one randomized controlled trial has compared operative and non-operative treatment of olecranon fractures in the elderly, but the study was stopped prematurely due to high complication rates in the group treated operatively and remained underpowered for important outcome measures.A few small patient series with non-operatively treated fractures also exist and suggest that it may be a valid alternative to operative treatment

Inclusion Criteria:

• Displaced olecranon fracture (Mayo 2A and 2B).

Exclusion Criteria:

• Associated fractures in the coronoid process, radial head or distal humerus.
• Open fracture, Gustilo-Andersen 2 or 3
• Severe cardiopulmonary disease or other medical condition which contraindicates surgery.
• Previous injury to or other condition in the elbow with serious functional impairment