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      SOFIE: Surgery for Olecranon Fractures in the Elderly: a randomised controlled trial of operative versus non-operative treatment

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          Abstract

          Background

          Displaced olecranon fractures after a simple fall are common in elderly patients. This patient group often has multiple medical co-morbidities and low functional demands. Standard treatment for these fractures has been operative fixation, using either wires or a plate. Recent case series suggest that such injuries can be managed without surgery with good functional outcomes. There has been no published trial comparing operative to non-operative treatment for displaced olecranon fractures.

          This project aims to test for superiority of operative treatment versus non-operative treatment for displaced olecranon fractures in the elderly, by comparing pain and function in the affected limb up to one year after the injury.

          Methods/Design

          SOFIE is an international study with a multicentre pragmatic randomised controlled trial design. The primary objective of the study is to compare a patient related outcome, the Disability of the Arm Shoulder and Hand (DASH) Score, between patients treated operatively and non-operatively at twelve months.

          Patients will be considered for the study if they are 75 years of age or older, medically fit for surgery, have an isolated displaced olecranon fracture, and present within 14 days of injury. Eligible patients willing to participate will be randomised either to operative fixation, with surgery using the preferred technique of the treating orthopaedic surgeon (tension band wiring or plate fixation), or to non-operative treatment involving early range of motion as tolerated.

          Secondary outcome measures will include pain, active range of motion, elbow extension strength, and any adverse events (infection, secondary interventions) at 3 and 12 months.

          Discussion

          The study will answer an important clinical question about the effectiveness of a commonly performed orthopaedic procedure, and will guide future treatment for displaced olecranon fractures in the elderly.

          Trial registration number

          World Health Organisation Universal Trial Number (WHO UTN) - U111111574090.

          Australian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12614000588695.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12891-015-0789-6) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references 20

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          Epidemiology of adult fractures: A review.

          The epidemiology of adult fractures is changing quickly. An analysis of 5953 fractures reviewed in a single orthopaedic trauma unit in 2000 showed that there are eight different fracture distribution curves into which all fractures can be placed. Only two fracture curves involve predominantly young patients; the other six show an increased incidence of fractures in older patients. It is popularly assumed that osteoporotic fractures are mainly seen in the thoracolumbar spine, proximal femur, proximal humerus and distal radius, but analysis of the data indicates that 14 different fractures should now be considered to be potentially osteoporotic. About 30% of fractures in men, 66% of fractures in women and 70% of inpatient fractures are potentially osteoporotic.
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            Rating systems for evaluation of the elbow.

            Many scoring systems have been used for elbow disorders. However, only few of these have been validated, and many assess only few aspects of elbow function. A literature search was performed using the keyword 'elbow' in combination with 'scoring system', 'outcome assessment', 'elbow disorder' and 'clinical evaluation'. Eighteen scoring systems are currently available for the evaluation of elbow disorders. Each of them evaluates the elbow performance using specific variables, including both objective and subjective criteria. All these scoring systems are presented. Although many scoring systems have been used to evaluate elbow function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive to clinically relevant changes, takes into account both patients' and physicians' perspective and is short and practical to use. Further studies are required to evaluate the reliability, validity and sensitivity of the elbow scoring systems used in the common clinical practice.
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              Complications of tension-band wiring of olecranon fractures.

               D Macko,  R Szabó (1985)
              We encountered a high incidence of complications related to the technique of tension-band wire fixation of displaced fractures of the olecranon in a five-year retrospective study of twenty patients (twenty fractures). All had been treated with primary open reduction using the AO technique of tension-band wiring. Twenty patients were followed at least to union as determined radiographically. The most frequent complication was symptomatic prominence of the Kirschner wires at the elbow in sixteen patients. There was skin breakdown in four patients, and infection developed in one. Measurable proximal migration of the Kirschner wires, however, occurred in only three patients. Prominence of the Kirschner wires usually was due to improper seating at the time of surgery (twelve of sixteen patients). Most complications that are related to this method of fixation may be avoided by careful attention to surgical technique.
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                Author and article information

                Contributors
                +61412650776 , drmichaelsymes@gmail.com
                ianharris@unsw.edu.au
                drjohnlimbers@gmail.com
                majoshi@mac.com
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                27 October 2015
                27 October 2015
                2015
                : 16
                Affiliations
                [ ]Gosford Hospital, Holden St, Gosford, NSW 2250 Australia
                [ ]Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, and South Western Sydney Clinical School, UNSW Australia, 1 Campbell St, Liverpool, NSW 2170 Australia
                Article
                789
                10.1186/s12891-015-0789-6
                4624605
                26507718
                © Symes et al. 2015

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Study Protocol
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                © The Author(s) 2015

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