Characteristics and Treatment of Isolated Pediatric Olecranon Fractures.

Abstract

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.