Paediatric olecranon fractures: a systematic review
Thomas J Holme1, Marta Karbowiak2, Magnus Arnander1,2
1St George's University Hospitals NHS Foundation Trust, London, UK.
Insights
Paediatric olecranon fractures displaced less than 4 mm heal well with non-operative treatment. Fractures displaced 4 mm or more benefit from operative management, with specific considerations for patient weight and associated injuries.
Area of Science:
- Orthopaedic surgery
- Paediatric orthopaedics
- Trauma surgery
Background:
- Olecranon fractures in children have poorly understood optimal management and long-term outcomes.
- A systematic review is needed to consolidate current evidence on paediatric olecranon fracture treatment.
Purpose of the Study:
- To systematically review the literature on the management of paediatric olecranon fractures.
- To analyze the long-term implications of different treatment strategies for these fractures.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of English-language studies on isolated paediatric olecranon fractures.
- Data extraction on demographics, classifications, treatments, and outcomes.
Main Results:
- Review of 15 articles (299 fractures in 280 patients).
- Non-operative treatment for fractures < 4 mm displacement yielded good results.
- Operative treatment for fractures ≥ 4 mm displacement showed generally good outcomes.
- Suture fixation failure associated with weight > 50 kg.
- Poorer outcomes noted with associated elbow injuries and in osteogenesis imperfecta patients.
Conclusions:
- Non-operative management is supported for isolated, undisplaced paediatric olecranon fractures.
- Operative management is recommended for displaced paediatric olecranon fractures (≥ 4 mm).
- Further research is needed due to the limited evidence base.
Abstract:
The optimal management and long-term outcomes of olecranon fractures in the paediatric population is not well understood. This systematic review aims to analyse the literature on the management of paediatric olecranon fractures and the long-term implications.A systematic review of several databases was conducted according to PRISMA guidelines. English-language studies evaluating the management of isolated paediatric olecranon fractures were included. Data extracted included demographics, classifications, conservative and operative treatment methods and outcomes.Fifteen articles fitting the inclusion criteria were included. There were 11 case series and four retrospective comparative series. The reported studies included 299 fractures in 280 patients.The mechanism of injury was predominantly low energy. Fractures displaced < 4 mm were treated non-operatively with almost universally good results, with the majority being treated with cast immobilization. Fractures displaced > 4 mm were commonly treated operatively with generally good results, with tension band wire and suture fixation being the most common treatment modalities. Weight > 50 kg was associated with failure of suture fixation.In those studies that reported olecranon fractures with associated elbow injuries (e.g. radial head fractures) outcomes were poorer. Forty-six fractures were in patients with osteogenesis imperfecta, who sustained a higher rate of re-fracture after removal of metalwork and contralateral olecranon fracture.Despite a relatively low evidence base pool of studies, the aggregate data support the non-operative treatment of isolated undisplaced olecranon fractures with good results, and support the operative treatment of fractures displaced ≥ 4 mm. Cite this article: EFORT Open Rev 2020;5:280-288. DOI: 10.1302/2058-5241.5.190082.
