Management of Olecranon Fractures in the Elderly: A Systematic Review and Meta-Analysis of Non-Operative, Limited Fixation and Operative Strategies

Author(s): Mr. Praveen Rajan, Mr. Vijay Patil, Mr. Yousef El-Tawil, Mr. Srinath Pammi, Mr. Aditya Vijay, Dr. Umair Baig, Dr. Bhargava Krishna Balineni, Dr. Venkata Nutalapati

Background: Olecranon fractures are common in the elderly, but the optimal management strategy remains controversial, with options ranging from non-operative care to standard operative fixation. This review aims to synthesie and compare outcomes of non-operative management, limited fixation, and operative fixation for olecranon fractures in patients aged ≥60 years.

Methods: A systematic review was conducted according to PRISMA guidelines. Databases (PubMed, Embase, Scopus, Cochrane Library) were searched from inception to March 2025 for studies reporting functional outcomes, complications, or reoperations. Two reviewers independently screened studies, extracted data, and assessed quality using MINORS and Cochrane tools.

Results: Nineteen studies (710 patients) were included. Functional outcomes (DASH/QuickDASH, MEPS) were good to excellent across all groups. Non-operative management (11 studies, n=257) for stable fractures yielded mean DASH scores ~13.8 and high patient satisfaction despite frequent radiographic nonunion (up to 80%). Limited fixation techniques (3 studies, n=179), such as suture anchors, showed promising results with mean DASH ~9.6 and lower reoperation rates than tension-band wiring (TBW). Operative fixation (12 studies, n=276) achieved reliable union but carried higher complication rates, especially with TBW. Pooled analysis found no significant functional difference between operative (mean DASH 13.6) and non-operative (mean DASH 12.5) arms, but reoperation rates were higher for surgery (24.7% vs. 6.1%).

Conclusion: In elderly patients, non-operative management is safe and effective for stable, low-demand cases. Limited fixation offers a viable middle ground with stable fixation and low implant morbidity. Operative fixation, preferably with plating, remains indicated for unstable fractures. Treatment should be individualised based on fracture pattern, bone quality, and patient demands.