Displaced olecranon fractures in the elderly: outcomes after non-operative treatment - a narrative review

Efficacy comparison of Kirschner-wire tension band and anchor loop plate in treatment of olecranon fracture

Objective: This study aimed to introduce a new surgical method for the fixation of olecranon fractures, and to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band and anchor loop plate (ALP) in the treatment of olecranon fractures. Methods: A finite element model was established to analyze the mechanical properties of Kirschner wire tension and anchor loop plate fixation for olecranon fracture. The clinical data of 53 patients with olecranon fractures admitted to our hospital from March 2016 to October 2021 were retrospectively analyzed. Among them, 22 cases were fixed with an anchor loop plate (ALP group), and 31 patients were fixed with the Kirschner wire tension band technique. By reviewing the medical records and follow-up results, the final elbow mobility, secondary surgery, postoperative complications and elbow function recovery Mayo score and DASH score were compared between the two groups. Results: The biomechanical analysis of the finite element model showed that under the load of 120 N, the maximum displacement of the Kirschner wire group was 1.09 times that of the ALP group, the maximum stress of the Kirschner wire group was 1.33 times that of the ALP group, and the maximum stress of the olecranon proximal bone of the Kirschner wire group was 2.17 times that of the ALP group. Under the load of 200 N, the maximum displacement of the Kirschner wire group was 1.19 times that of the ALP group. The overall maximum stress of the Kirschner wire group was 1.59 times that of the ALP group, and the maximum stress of the proximal olecranon bone of the Kirschner wire group was 1.99 times that of the ALP group. The average follow-up time of the Kirschner wire and anchor loop plate groups was similar (p > 0.05). The average age of the two groups was identical (p > 0.05). The final elbow mobility in the anchor loop plate group was significantly greater than in the Kirschner wire group (p < 0.05). The Mayo score of the anchor loop plate group was substantially higher than that of the Kirschner wire group at 3 and 12 months after operation (p < 0.05), and the DASH score was significantly lower than that of the Kirschner wire group (p < 0.05). Postoperative complications in the two groups: 1 case (4.5%) in the anchor loop plate group had difficulties with internal fixation stimulation, and no infection occurred; in the Kirschner wire group, 5 cases (16.1%) had complications of internal fixation stimulation, and 1 patient (3.2%) had an infection. Conclusion: The model of olecranon fracture fixed by anchor loop plate and Kirschner wire tension technique was tested under 120 and 200 N tension, and no damage was found, indicating that the newly designed anchor loop plate was safe in mechanical structure. The biomechanical stability of the anchor plate technique is more stable, so it is not easy to have postoperative complications such as fracture block cutting and internal fixation failure. And the secondary operation rate and elbow function have better results. This technique is an effective method for the treatment of olecranon fractures.

Cost minimization analysis of the treatment of olecranon fracture in elderly patients: a retrospective analysis

Background

Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients.

Methods

Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payer perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications.

Results

One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs US$2,544). 31.05% of operative cases were associated with a significant complication compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs $2,320).

Conclusions

These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payers shift toward value-based reimbursement models in which quality of care and cost influence surgical decision making.

Level of Evidence

Level IV.

Olecranon Fracture in an Older Adult Treated With Locking Plate Osteosynthesis

Although olecranon fractures are not uncommon in the geriatric population, there has been a considerable difference of opinion between surgical and nonsurgical treatments. Surgical treatment is usually deferred in the elderly, even for displaced olecranon fractures, because of inherent risks associated with poor bone quality and soft tissues, which often necessitate further surgeries. However, nonoperative treatment frequently results in an inability to regain full extension strength of the elbow, which can be disabling in select older adults with higher functional demands. We present an active older adult with a displaced olecranon fracture, who achieved a satisfactory result after open reduction and internal fixation (ORIF) using a low-profile locking plate.