What is the management of a nondisplaced olecranon fracture?

Management of Nondisplaced Olecranon Fractures

Nondisplaced olecranon fractures should be treated with nonsurgical immobilization in a posterior splint or cast for 2-3 weeks followed by progressive mobilization. 1, 2

Initial Management

• Nondisplaced olecranon fractures (with less than 5mm displacement) can be successfully treated with conservative management, with studies showing 93% satisfactory results with this approach 3
• A posterior splint or back-slab immobilization is preferred over collar and cuff, as it provides better pain relief during the first 2 weeks after injury 4
• The elbow should be immobilized in a position that maintains fracture alignment, typically in slight flexion (30-45 degrees) 2

Duration of Immobilization

• Short period of immobilization (2-3 weeks) is recommended to prevent joint stiffness, which is a common complication of prolonged immobilization 2
• After the initial immobilization period, gradually increasing range of motion exercises should be initiated to minimize stiffness 2

Follow-up Care

• Regular radiographic evaluation should be performed during the first 3 weeks of treatment and at the cessation of immobilization to ensure the fracture remains nondisplaced 4
• If displacement occurs during conservative treatment, surgical intervention may become necessary 1
• Functional rehabilitation using active assisted range of motion exercises should be started after the immobilization period 5

Special Considerations

• Conservative treatment is particularly appropriate for:
  • Truly nondisplaced fractures (less than 2mm displacement) 2
  • Elderly patients who would be poor surgical candidates 1
  • Pediatric patients with nondisplaced or minimally displaced fractures 3

Surgical Indications

• Surgery should be considered if:
  • The fracture displaces during conservative treatment 2
  • There is more than 2-5mm of displacement or articular incongruity 2
  • The patient requires earlier functional recovery and has good bone quality 6

Complications to Monitor

• Joint stiffness is the most common complication of conservative treatment, although it usually does not prevent good function 3
• Loss of motion may occur but typically does not significantly impact functional outcomes in most patients 3
• Regular assessment for displacement is critical, as secondary displacement would necessitate surgical intervention 1

Pitfalls and Caveats

• Avoid prolonged immobilization beyond 3 weeks as it significantly increases the risk of permanent elbow stiffness 2
• Ensure proper positioning during immobilization to maintain fracture alignment 2
• Be aware that elderly patients with osteoporotic bone may have higher rates of secondary displacement during conservative treatment 6
• Consider patient's functional demands and compliance with treatment when deciding between conservative and surgical management 1