OLECRANON FRACTURES IN PATIENTS 70 YEARS OF AGE AND OLDER: A RETROSPECTIVE COHORT STUDY OF OPERATIVE VERSUS NONOPERATIVE MANAGEMENT

With an aging population, the incidence of olecranon fractures in older patients is increasing. The standard of care has traditionally included operative management for displaced fractures. Recent literature has called this standard of care into question. Older patients may be at increased risk of operative complications and may have satisfactory functional outcomes with nonoperative management. There is a paucity of evidence informing treatment decision making in this population. We conducted a retrospective cohort study including all displaced, stable olecranon fractures in individuals > 70 years of age treated since 2019 at our institution. Radiographs at the time of diagnosis were reviewed as were all follow-up radiographs and clinical notes. Patients were also contacted by telephone and invited to participate in completion of Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient Reported Outcomes Measurement Information System (PROMIS) global health and upper extremity, and Physical Ability Score in the Elderly (PASE) questionnaires. Data from 69 patients were included, 26 of whom were treated non-operatively (mean age 86.7 ± 7.9 years) in either a splint or sling (mean duration of immobilization 3.5 ± 2.8 weeks), and 43 of whom were treated operatively (mean age 78.1 ± 7.3 years), largely with locking plate fixation (n = 41 / 43). Mean follow-up since injury was similar between non-operative (29 ± 9 months) and operative groups (29 ± 14 months). There was no difference in baseline comorbidities between groups, as analyzed using the Charlson Comorbidity Index. There was no difference in QuickDASH between groups (non-operative 23 ± 18, operative 13 ± 18, p = 0.098, minimally important difference = 10). PROMIS upper extremity score was higher in the operative group than in the non-operative group (30.0 ± 7.9 and 19.1 ± 7.8, respectively; p = 0.004). Patients treated operatively were more active at final follow-up according to the PASE score. There was one minor complication and no conversion to operative management in the non-operative group. In the operative group, there were 15 total complications (34.9%), six of which (14.0%) were major (n = 2 delirium, n = 2 revision surgery for implant failure, n = 2 deep infection). Eight patients in the operative group required reoperation (n = 4 elective implant removal, n = 4 revision for implant failure or infection). We found no difference in PROMIS global health physical or mental scores, range of motion, or visual analogue pain. Regression to examine the effect of age, Charlson Comorbidity Index, and extensor mechanism integrity at presentation will be conducted. In patients >70 years old, non-operative management may provide satisfactory function for most daily tasks (represented by QuickDASH) without the risk of operative intervention. In higher-demand patients (captured by PROMIS upper extremity score), operative treatment may result in better extremity function without an impact on overall quality of life. Our investigation was limited by large confounding variables including age and activity level. Prospective investigations are needed to identify patient characteristics favoring operative or non-operative management.