Elderly Olecranon Fractures: How and When to Manage Them Operatively and Nonoperatively

Nonoperative management of the rare stable undisplaced olecranon fracture is routine, with plate fixation recommended for a displaced olecranon fracture associated with elbow instability. Internal fixation is often used for stable displaced olecranon fractures, with tension band wire fixation and plate fixation employed. However, this dogma has been challenged for elderly lower demand patients where poor fixation in osteoporotic bone, a delicate soft tissue envelope, symptomatic metalwork, and the risk of further surgery occur. There is increasing data to support nonoperative management in these patients, even in the presence of displacement or comminution.