Aibinder William R, Sims Laura A, Athwal George S, King Graham J W, Faber Kenneth J
Department of Orthopaedic Surgery & Rehabilitation Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Orthopedics, University of Saskatchewan, Saskatoon, SK, Canada.
JSES Int. 2021 Jan 10;5(2):291-295. doi: 10.1016/j.jseint.2020.11.001. eCollection 2021 Mar.
Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients.
A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months. The mean age at the time of injury was 79 ± 10 years. The average Charlson Comorbidity Index was 6.4 ± 2.6. Treatment modalities were at the discretion of the treating surgeon. A sling alone was used in 3 cases, an extension circumferential cast in 9, or a plaster or thermoplastic splint in 16. The mean period of immobilization was 5 ± 1 weeks. Outcomes included range of motion, ability to perform active overhead extension, as well as radiographic and functional outcomes.
At final follow-up, the mean elbow range of motion for the cohort was from 28° ± 21° extension to 127° ± 15° flexion. Active overhead elbow extension against gravity was noted or documented in 24 (86%) patients. Two patients (7%) were unable to perform active extension. No pain was noted in 18 elbows, severe pain was present in 1 elbow, and the remainder reported mild occasional pain. All olecranon fractures in this cohort were displaced on the initial lateral radiograph. The mean displacement was 11 ± 7 mm. Nonunion at final radiographic outcome was observed in 23 (82%) elbows. Two (7%) patients developed skin complications related to posteriorly placed splints; one of which was severe.
This study adds to the growing literature that supports nonoperative management of displaced olecranon fractures in elderly and medically unwell patients with low upper extremity demand. Patients can be counseled that they have a good chance of obtaining overhead extension, with minimal pain. Posteriorly based splints should not be used to minimize skin complications.
老年移位性鹰嘴骨折的手术治疗并发症发生率高，包括伤口裂开和内固定失败。本研究的目的是评估低需求老年患者和身体状况不佳患者非手术治疗移位性鹰嘴骨折的临床、影像学和功能结局。
对28例闭合性移位性鹰嘴骨折患者进行回顾性研究，平均随访11个月。受伤时的平均年龄为79±10岁。平均查尔森合并症指数为6.4±2.6。治疗方式由主刀医生决定。3例仅使用吊带，9例使用伸直位环形石膏，16例使用石膏或热塑性夹板。平均固定时间为5±1周。结局包括活动范围、主动过顶伸直能力以及影像学和功能结局。
在最后一次随访时，该队列患者的平均肘关节活动范围为伸直28°±21°至屈曲127°±15°。24例（86%）患者可进行主动过顶抗重力伸直，2例（7%）患者无法进行主动伸直。18个肘关节无疼痛，1个肘关节有严重疼痛，其余患者报告偶尔有轻度疼痛。该队列所有鹰嘴骨折在初始侧位X线片上均有移位，平均移位为11±7mm。最终影像学检查结果显示23个（82%）肘关节出现骨不连。2例（7%）患者出现与后侧夹板相关的皮肤并发症，其中1例严重。
本研究进一步丰富了支持对上肢需求低的老年和身体状况不佳患者的移位性鹰嘴骨折进行非手术治疗的文献。可以告知患者，他们有很大机会实现过顶伸直，且疼痛最小。不应使用后侧夹板以尽量减少皮肤并发症。
