Pilot report: non-operative treatment of Mayo Type II olecranon fractures in any-age adult patient

Abstract

Background: We report on the non-operative treatment of Mayo Type II olecranon fractures.

Methods: Fourteen isolated Mayo Type II olecranon fractures were treated non-operatively, followed to discharge, and retrospectively reviewed. Treatment was splinting in extension followed by protected active motion beginning 3 weeks to 4 weeks post-injury. Mayo Elbow Performance Index (MEPI) and Shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were available in 86% and 64% of cases, respectively. Follow-up radiographs were obtained.

Results: At discharge, the mean (SD) MEPI score was 95 (5). The mean (SD) elbow motion arc was 121° (21°). One patient re-fractured his elbow after discharge by falling on the ice. He recovered after open reduction and internal fixation. One patient (documented Marfan syndrome) developed an asymptomatic non-union. Excepting the patient who fell, no patient received additional care.

Conclusions: In this pilot report, Mayo Type II olecranon fractures were treated non-operatively to discharge. Good to excellent results were obtained in all patients according to the MEPI. Supportive care of these fractures should be comparatively studied. A downside risk to providing supportive care for these fractures was not identified.

Keywords: MEPI; QuickDASH; closed olecranon fracture; nonoperative care; splinting; type 2 olecranon fracture.

Figure 1.

Patient 1. (a) Follow-up anteroposterior (AP) radiograph showing maintenance of ulnohumeral stability. (b) Follow-up lateral radiograph showing non-union of olecranon with no anterior translation of the ulnohumeral joint. (c) At 6 weeks post-fracture, the patient has full painless flexion (affected side is patient’s right, opposite to watch). (d) Same conditions as (c), with elbow in full painless extension.

Figure 2.

Patient 2. (a) Initial lateral plain film radiograph demonstrates a Type II olecranon fracture. (b) Subsequent lateral plain film radiograph at 4 weeks demonstrates callus formation and healing of the fracture. (c) At 6 weeks post-fracture, the patient was able to do push-ups against resistance (elbow extended, affected side towards the camera). (d) Same conditions as (c), with elbow in flexion.

Figure 3.

(a) Proximal (p) and distal (d) sesamoids related to a hypothetical joint. (b) Conversion of distal sesamoid into a traction epiphysis. Reporoduced with permission.