What is the treatment for olecranon process fracture?

From the Guidelines

Surgery is the usual treatment for olecranon process fractures, with simple immobilization being appropriate for small, nonarticular, or minimally displaced fracture fragments. When considering the treatment of olecranon process fractures, it's essential to prioritize the type and displacement of the fracture.

Key Considerations

• The diagnosis of olecranon process fractures is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1.
• For non-displaced or minimally displaced fractures, conservative management may be sufficient, but this approach may not always be the best option in terms of morbidity, mortality, and quality of life.
• Displaced fractures typically require surgical intervention to restore function and prevent long-term disability.

Treatment Approach

• Surgical intervention is preferred for active patients to restore function and prevent long-term disability, as the olecranon is crucial for elbow stability and triceps function.
• Post-operative care includes immobilization for 1-2 weeks, followed by progressive rehabilitation focusing on range of motion exercises and gradual strengthening.
• Pain management typically involves NSAIDs, with short-term opioids for severe pain, and monitoring for complications such as hardware irritation, nonunion, and ulnar nerve symptoms.

Prioritizing Outcomes

• In the context of real-life clinical medicine, it's crucial to prioritize the patient's quality of life, morbidity, and mortality when deciding on the treatment approach for olecranon process fractures.
• The most recent and highest quality study available should guide the treatment decision, even if the evidence is not directly related to the specific context of the question 1.

From the Research

Treatment Options for Olecranon Process

• The treatment of olecranon fractures typically involves open reduction and internal fixation for displaced intra-articular fractures 2.
• Nondisplaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion 2.
• Stable internal fixation with figure-of-eight tension-band wire fixation is suitable for simple transverse fractures, allowing for early motion to minimize stiffness 2.
• Plate fixation is recommended for severely comminuted fractures, distal fractures involving the coronoid process, oblique fractures distal to the midpoint of the trochlear notch, Monteggia fracture-dislocations of the elbow, and nonunions 2.

Management of Olecranon Bursitis

• Olecranon bursitis can be septic or non-septic, with trauma being a common cause of both types 3.
• Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue 3.
• Septic olecranon bursitis should be treated by aspiration and a long course of antibiotics, while non-septic olecranon bursitis can be managed with aspiration alone and non-steroidal anti-inflammatory drugs 3, 4.
• Intrabursal corticosteroids can produce rapid resolution but may have long-term local effects, and their use is controversial 3, 4, 5.

Non-Surgical Treatment of Aseptic Olecranon Bursitis

• Aseptic olecranon bursitis can be treated with conservative methods such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications 4, 5.
• Corticosteroid injection (CSI) can be effective but is associated with a higher number of complications, including bursal infection and skin atrophy, and should be reserved for refractory cases 5.
• The clinical resolution of aseptic olecranon bursitis can occur with conservative methods if implemented earlier in the disease course 5.