Characteristics and Treatment of Isolated Pediatric Olecranon Fractures

Olecranon fractures are uncommon injuries in the pediatric population. Minimally displaced olecranon fractures are treated nonoperatively, but there is no consensus on a cutoff point for displacement requiring surgical treatment. The aim of this study is to report a large cohort of children with olecranon fractures and to identify patient and radiographic factors associated with favorable outcomes after treatment.

A retrospective review was conducted on patients aged 0 to 15 years with olecranon fractures treated at a single institution between 2002 and 2023. Radiographic measurements of intra-articular displacement on lateral views were collected, with follow-ups until confirmed fracture union for isolated olecranon fractures. Olecranon fracture locations were identified as zone 1 (proximal 1/3), 2 (middle 1/3), or 3 (distal 1/3). Medical records were reviewed for type of treatment, outcomes, and complications. Patient-Reported Outcomes Measurement Information System (PROMIS) data were collected for patients treated after January 1, 2015.

A total of 140 patients met inclusion criteria, with an average age of 8 years. Nonoperative management was utilized in 105 (75%) patients, and open reduction and internal fixation (ORIF) in 35 (25%) patients. In the nonoperative group, mean intra-articular displacement was 0.9 mm compared with 7.0 mm in the operated group, P <0.001. Displacement of <3 mm was observed in 104 patients, whereas 36 had displacement ≥3 mm. For patients with displacement <3 mm, 101 (97%) were treated nonoperatively ( P <0.001), compared with ORIF in 32 (89%) patients with ≥3 mm displacement; P <0.001. At follow-up between weeks 9 and 12, no difference in average PROMIS upper extremity and pain scores was observed between the <3 mm and ≥3 mm displacement group (44.3±12.6 vs. 45.9±10.4, P =0.710; 41.4±11.9 vs. 41.5±11, P =0.987).

Isolated olecranon fractures with <3 mm of displacement can be safely and effectively treated nonoperatively. Given our institutional approach for operative treatment in patients with ≥3 mm of intra-articular displacement, good outcomes can be expected.

Level III: therapeutic studies-investigating the results of treatment.