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      Displaced olecranon fractures in the elderly: outcomes after non-operative treatment – a narrative review

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          Abstract

          • Operative treatment with tension band wiring or plate is the gold standard of care for displaced olecranon fractures.

          • In elderly patients, multiple comorbidities combine with increased intraoperative risks, and postoperative complications may yield poor results.

          • There are small series in the literature that show promising results with non-operative treatment.

          • Non-operative treatment may provide reasonable function and satisfaction in the elderly population and could be considered as a treatment option in this group, especially for those with comorbidities, to avoid postoperative complications and the need for re-operation.

          Cite this article: EFORT Open Rev 2020;5:391-397. DOI: 10.1302/2058-5241.5.190041

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          The epidemiology of fractures of the proximal ulna.

          Andrew D Duckworth, Nicholas Clement, Stuart Aitken … (2012)
          The aim of our study was to report the epidemiological characteristics of fractures of the proximal ulna.
          Article 0 comments Cited 41 times – based on 0 reviews     Review now
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            Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study

            Byron E Chalidis, Nick C Sachinis, Efthimios Samoladas … (2008)
            Background Tension band wiring (TBW) remains the most common operative technique for the internal fixation of olecranon fractures despite the potential occurrence of subjective complaints due to subcutaneous position of the hardware. Aim of this long term retrospective study was to evaluate the elbow function and the patient-rated outcome after TBW fixation of olecranon fractures. Methods We reviewed 62 patients (33 men and 29 women) with an average age of 48.6 years (range, 18–85 years) who underwent TBW osteosynthesis for isolated olecranon fractures. All patients were assessed both clinically with measurement of flexion-extension and pronation-supination arcs and radiologically with elbow X-Rays. Functional outcome was estimated using the Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS) subjective pain score and VAS patient satisfaction score. Follow up: 6–13 years (average 8.2 years). Results There was a higher prevalence of fractures among men until the 5th decade of life and among women in elderly (p = 0.032). Slip or simple fall onto the arm was the main mechanism of injury for 38 fractures (61.3%) while high energy trauma, such as fall from a height (> 2 m) or road accident, was reported in 24 fractures (38.7%). Hardware removal performed in 51 patients (82.3%) but 34 of them (66.6% of removals) were still complaining for mild pain during daily activities. The incidence of pin migration and loosening was not statistically decreased when penetration of the anterior ulnar cortex was accomplished (p = 0.304). Supination was more often affected than pronation (p = 0.027). According to MEPS, 53 patients (85.5%) had a good to excellent result, 6 (9.7%) fair and 3 (4.8%) poor result. The average satisfaction rating was 9.3 out of 10 (range, 6–10) with 31 patients (50%) to remain completely satisfied from the final result. Degenerative changes recorded in 30 elbows (48.4%). However, no correlation could be found between radiographic findings and MEPS (p = 0.073). Conclusion Tension band wiring fixation remains the "gold standard" for the treatment of displaced and minimally comminuted olecranon fractures. In long term, low levels of pain may be evident regardless of whether the metalware is removed and degenerative changes have been developed.
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              Plate Versus Tension-Band Wire Fixation for Olecranon Fractures: A Prospective Randomized Trial.

              Andrew D Duckworth, Nicholas Clement, Timothy O White … (2017)
              The aim of this single-center, single-blinded, prospective randomized trial was to compare the outcomes of tension-band wire (TBW) and plate fixation for simple isolated, displaced fractures of the olecranon.
              Article 0 comments Cited 33 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): EFORT Open Rev
                Journal ID (iso-abbrev): EFORT Open Rev
                Title: EFORT Open Reviews
                Publisher: British Editorial Society of Bone and Joint Surgery
                ISSN (Electronic): 2058-5241
                Publication date Collection: July 2020
                Publication date (Electronic): 1 August 2020
                Volume: 5
                Issue: 7
                Pages: 391-397
                Affiliations
                [1 ]First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, ‘ATTIKON’ University General Hospital, Athens, Hellenic Republic, Greece
                [2 ]Department of Orthopaedic Surgery, Mediterraneo Hospital, Athens, Greece
                [3 ]Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras 26504, Greece
                Author notes
                [*]Olga D. Savvidou, First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, School of Medicine, ‘ATTIKON’ University General Hospital, Athens, Hellenic Republic, Greece, 4, Riga Fereou St., 15342, Agia Paraskevi, Greece. Email: olgasavvidou@ 123456gmail.com
                Article
                Publisher ID: 10.1302_2058-5241.5.190041
                DOI: 10.1302/2058-5241.5.190041
                PMC ID: 7407865
                PubMed ID: 32818066
                SO-VID: b1c9a84e-2d5e-4695-8e6e-ad3854377227
                Copyright © © 2020 The author(s)
                License:

                This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

                History
                Categories
                Subject: Shoulder & Elbow
                Subject: 12
                Subject: Complications
                Subject: Elderly
                Subject: Fractures
                Subject: Non-Operative Treatment
                Subject: Olecranon

                Keywords: complications,elderly,fractures,non-operative treatment,olecranon
                Data availability:
                Keywords: complications, elderly, fractures, non-operative treatment, olecranon

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