This article reviews the long-term outcome of closed olecranon fractures in 73 patients at a mean of 19 years after the fracture. 65% of the fractures were displaced more than 2mm and 22% were comminuted. 84% were treated with open reduction internal fixation; the techniques included figure of 8 wiring on 40% and AO tension band wiring in 41%. Immediately after surgery, the incongruity of the joint fracture was more than 2mm in more than 21% with an overall mean of 1.9mm. Only one nonunion occurred and this patient was without subjective complaints. 48% of the patients had their hardware removed. Radiographic degenerative changes as described as subchondral cysts, sclerosis or osteophytes were found in 50% of radiographs at final follow-up compared to 11% on the uninjured arm. Radiographic signs of osteoarthritis as defined by joint space narrowing greater than 1mm and findings of degenerative changes were noted in 6% of the injured elbows versus 0% of the uninjured elbows. Overall subjective outcome included 84% with an excellent outcome, 12% with a good outcome and 3% with a poor outcome secondary to pain at rest and during activity and reduced range of motion. Two of the 3 patients with severe symptoms had a high energy injury with a fracture involving the middle 1/3 of the olecranon and osteoarthritis. Approximately 1/3 of these elbows had a deficit in flexion or extension at final follow-up compared to the uninjured elbow. However, only one elbow had a flexion deficit greater than 20 degrees (55 degrees) and three elbows had an extension deficit greater than 20 degrees (25 degrees, 25 degrees, and 35 degrees, respectively). Ulnar neuritis was not significantly different between the injured and uninjured elbows.
This study confirms that isolated closed fractures of the olecranon have a favorable long-term outcome. Although 48% required a second operation to remove the hardware, and degenerative radiographic changes were noted radiographically in 50%, 84% of patients had no complaints at follow-up and 96% had an excellent or good outcome. Slightly reduced range of motion commonly found following olecranon fractures was not significant and osteoarthritis developed in only 6% with only ½ of these patients exhibiting symptoms related to joint space narrowing.