Nonoperative management of olecranon fractures in the working age patient: A case series

Operative treatment is the standard of care for the majority of olecranon fractures in working-age patients. However, nonoperative management may be indicated for non-injury reasons in this population. Current literature on nonoperative management for olecranon fractures is limited to the low-demand geriatric population. This study aimed to report outcomes following primary nonoperative management of olecranon fractures in working-age patients.

All consecutive patients aged 18-65 years managed nonoperatively for an olecranon fracture at two Level 1 Trauma Centers between 2016 and 2023 with ≥3 months follow-up were retrospectively identified. Clinical outcomes were collected at a median of 12 weeks (IQR: 9-29) and included range of motion and complications. Radiographic healing was assessed at a median of 18 weeks (IQR: 9-30). Long-term Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcomes were collected by telephone survey for 8 patients at a median of 3 years (IQR: 2-4).

Seventeen patients with 9 (50 %) Mayo type 1A, 5 (28 %) type 2A, and 4 (22 %) type 2B fractures were identified. The median age was 50 years (IQR: 31-55). All Mayo type 1 fractures demonstrated either complete healing or progressive signs of healing at final follow-up. Five (56 %) Mayo type 2 fractures demonstrated no evidence of healing but preserved a functional active flexion-extension arc. MEPS and QuickDASH outcomes (available for 6 Mayo type 1 fractures and 2 Mayo type 2) varied greatly, with 6 (75 %) patients able to perform all assessed activities of daily living and 4 (50 %) reporting persistent pain.

Nonoperative treatment for Mayo type 1 olecranon fractures leads to satisfactory healing. Mayo type 2 fractures may lead to functional nonunion with variable pain. Long-term patient-reported outcomes may vary considerably and should be subject of further study for both fracture types.

Level IV.