From the Guidelines
Surgery is the usual treatment for olecranon fractures, with simple immobilization appropriate for small, nonarticular, or minimally displaced fracture fragments. When considering treatment for olecranon fractures, it's crucial to prioritize morbidity, mortality, and quality of life as outcomes. According to the American College of Foot and Ankle Surgeons 1, the diagnosis of olecranon fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies.
For non-displaced fractures, treatment involves immobilization, while displaced fractures require surgical intervention. Key considerations include:
- Immobilization in a long arm cast or splint for non-displaced fractures
- Surgical fixation for displaced fractures, using techniques like tension band wiring, plate fixation, or intramedullary screw fixation
- Post-surgery immobilization and physical therapy to ensure proper healing and functional outcomes
- Monitoring for complications such as hardware irritation, nonunion, malunion, and post-traumatic arthritis
In terms of pain management, options include:
- NSAIDs like ibuprofen or naproxen
- Acetaminophen as an alternative
- Regular follow-up with radiographs to ensure proper healing and address any potential complications.
From the Research
Treatment Options for Olecranon Fractures
- Surgical intervention is often required for olecranon fractures due to the pull of the triceps muscle, which can lead to fracture displacement 2.
- Treatment options include:
- Tension band wiring: a common method for simple transverse fractures, allowing for early motion to minimize stiffness 3.
- Open reduction internal fixation with a pre-contoured locking plate: suitable for complex or comminuted fractures 2, 3.
- Tension band suture fixation: an all-suture technique that maintains inter-fragmentary compression and reduces the rate of re-operation caused by prominent metalwork 4.
- Plate fixation: appropriate for severely comminuted fractures, distal fractures involving the coronoid process, or nonunions 3.
- Fragment excision and triceps advancement: may be considered in selected cases, such as osteoporotic elderly patients with severely comminuted fractures 3.
Non-Surgical Management
- Undisplaced fractures or displaced fractures in older patients can be managed conservatively with an above elbow cast for 4 weeks 2.
- Non-displaced fractures can be treated with a short period of immobilization followed by gradually increasing range of motion 3.