We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment.

We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction.

Cite this article: Bone Joint J 2014;96-B:530–4.

Introduction and Objectives: Lack of consolidation of the distal extremity of the radius (DER) is extremely rare (0.05–0.9%) and no more than 75 cases have been published between 1944 and 2008. We wish to present our experience in the treatment of this condition.

Materials and Methods: This is a prospective study of 13 patients (10 men and 3 women) with non-union of the distal extremity of the radius (DER). Mean age of the patients was 52 years (26–76 years) and 53% were smokers. Initial treatment of the fracture was surgical in 9 cases (70%), 3 were open and there was infection in 4 cases. Treatment of the non-union was surgical in 10 cases (77%) at a mean time of 7.8 months: 70% graft + fixation (5 volar plates, 1 double plate and 1 external fixator) and 30% arthrodesis (2 total and 1 partial). In 80% of cases a Darrach technique was also used. We assessed VAS, DASH, range of mobility, complications, consolidation and work-related results, with a mean 12 month (6–24 months) follow-up.

Results: Mean flexoextension: 72.7°. Pronosupination: 171.2°. Mean VAS: 2.4. DASH questionnaire: 30,75. None of the patients was reoperated. Complete consolidation was achieved in 100% of the operated cases. The off-work period after surgery was 358 days and 80% of the patients returned to the same job with some limitations.

Discussion and Conclusions: No statistically significant differences were found between the treatment performed and the final result. With orthopedic treatment there was more pain and a worse DASH score. Arthrodesis patients had less days off-work than those treated with grafts and osteosynthesis.