The purpose of this paper was to identify the outcomes and acceptability of nonoperative against operative (tension band wire) management of olecranon fractures in patients older than 74 yr.
Retrospective analysis of all adult patients presenting with olecranon fractures over the last 2 yr, with a minimum of 6 mo follow-up.
Of 74 patients, 36 underwent tension band wiring, 14 underwent plating, and 24 were managed nonoperatively. Patients with less than 5 mm displacement showed no difference in pain or function between the treatment modes. Those with 5-10 mm of displacement in the older than 74 yr group had significantly lower mean pain scores when managed nonoperatively, 1.28 compared with 4.75 (P=0.0070). They also had numerically worse functional scores, though not significant, 27.25 compared with 9.18 (P=0.0855). Patients with 10-20 mm displacement again showed no significant difference in pain or function between tension band wiring and nonoperative treatment. All patients with displacement of more than 20 mm underwent operative fixation with tension band wiring, however. Mean pain and function scores were generally quite poor in this group in both age ranges. There were 14 reoperations in the tension band wiring group, four of which were in patients older than 74 yr.
Nonoperative treatment of displaced olecranon fractures in the older population is an acceptable treatment option avoiding risks of surgery and resulting in low pain and reasonable function, equivalent to tension band wiring.