Further Displacement After Initial Nonsurgical Treatment of Minimally Displaced Olecranon Fractures in Children

Pediatric olecranon fractures are uncommon periarticular injuries with unclear treatment guidelines for varying magnitudes of intra-articular displacement. Similar to other pediatric elbow fractures, minimally displaced fractures are treated nonsurgically, and potential for further displacement following nonsurgical treatment exists. This study assesses the incidence and risk factors for further displacement after nonsurgical treatment of minimally displaced pediatric olecranon fractures.

A retrospective review was conducted on patients aged 0 to 15 years with isolated olecranon fractures treated nonsurgically at a single institution. Radiographic measurements of intra-articular and nonarticular displacement on lateral views were collected with follow-up imaging done until confirmed radiographic union. Patients with more than 1-mm change in displacement on the articular side during treatment were identified. Fractures were classified at specified locations, including zone 1 (proximal 1/3), zone 2 (middle 1/3), and zone 3 (distal 1/3).

A total of 64 patients met inclusion criteria, 42 (65.6%) were males, and the average age at injury was 8.25 years. Casting without closed reduction was the definitive treatment method in 59 patients (92.2%). Of the fractures observed, 30 (46.9%) occurred in zone 1, followed by 23 patients (35.9%) in zone 2 and 11 patients (17.2%) in zone 3. Interval displacement was seen in 14 patients at follow-up visits (21.9%) with greater body mass index observed in the redisplacement group ( P = 0.053). Change in management was required in two patients (3.1%). Displacement of ≥1 mm at initial evaluation did not affect the rate of subsequent displacement at follow-up visit ( P = 0.571). Neither fracture zone nor fracture configuration were statistically significant for change in fracture displacement.

Further displacement was observed in 20% of minimally displaced olecranon fractures regardless of the zone and magnitude of initial displacement with a small percentage leading to a change in the management. Close radiographic follow-up for nonsurgically treated olecranon fractures is recommended.