The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Non-Operative Management of a Failed Olecranon Fracture Fixation Leading to Functional Recovery: A Case Report

Document Type : CASE REPORT

Authors
Roya Khorram
Matthew Parkis
Amir Kachooei
Rothman Orthopaedics Florida at AdventHealth, Orlando, FL, USA
10.22038/abjs.2025.92034.4172
Abstract
An 85-year-old female walker dependent presented with a displaced olecranon fracture following a fall. Open reduction and internal fixation (ORIF) using an anatomic olecranon locking plate was performed. Two-week postoperative X-rays revealed fixation failure with persistent fragment displacement and a wide fracture gap. To manage this condition, non-operative management, including sling immobilization for 4 weeks and progressive physical therapy, was pursued with the elbow at 90 degrees flexion. At the 6-month follow-up, the elbow was pain-free with functional range of motion (ROM) being achieved, and functional independence was observed in daily activities including using a walker. This case highlights the potential for successful functional recovery through non-operative management in geriatric patients as an initial treatment or after a failed ORIF, emphasizing the importance of tailoring treatment to patient-specific factors and functional goals over radiographic outcomes.
        Level of evidence: V
Keywords
Bone plate
Case study
Conservative treatment
Elderly
Olecranon fractures
Treatment failure
Subjects
  1. Brolin TJ, Throckmorton T. Olecranon fractures. Hand Clin. 2015;31(4):581-590. doi:10.1016/j.hcl.2015.07.003.
  2. Fones L, Kachooei AR, Beredjiklian PK. Trends in Orthopaedic Surgery on Patients 90 Years Old and Older 2014-2023. Arch Bone Jt Surg. 2025;13(3):157. doi:10.22038/ABJS.2024.82754.3768.
  3. Alvara CA, Biedron G, Dunn JC. Nonoperative management of olecranon fractures in elderly patients: a systematic review. Hand (N Y).2022;17(4):734-739. doi: 10.1177/1558944720944261.
  4. Metikala S, Poulos NG, Hasan K, Vallem MMR. Olecranon fracture in an older adult treated with locking plate osteosynthesis. Cureus.2021;13(10):e18836. doi: 10.7759/cureus.18836.
  5. Powell A, Farhan-Alanie O, Bryceland J, Nunn T. The treatment of olecranon fractures in adults. Musculoskelet Surg.2017;101(1):1-9. doi: 10.1007/s12306-016-0449-5.
  6. Wise KL, Peck S, Smith L, Myeroff C. Locked plating of geriatric olecranon fractures leads to low fixation failure and acceptable complication rates. JSES Int.2021;5(4):809-815. doi: 10.1016/j.jseint.2021.02.013.
  7. Barlow J, Mallett KE. Open Reduction and Internal Fixation (ORIF) for Distal Humerus Fractures. Tips and Techniques in Elbow Surgery: A Practical Approach. Springer; 2022:9-17.
  8. Bateman DK, Barlow JD, VanBeek C, Abboud JA. Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique. J Shoulder Elbow Surg.2015;24(7):1090-7. doi: 10.1016/j.jse.2015.02.017.
  9. Bouchard C, Bornes TD, Silveira A, Hemstock R, Beaupre L, Chan R. Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study. J Shoulder Elbow Surg.2022;31(9):e418-e425. doi: 10.1016/j.jse.2022.04.006.
  10. von Keudell A, Kachooei A, Mohamadi A, et al. Biomechanical properties of an intramedullary suture anchor fixation compared to tension band wiring in osteoporotic olecranon fractures-A cadaveric study. J Orthop.2019:17:144-149. doi: 10.1016/j.jor.2019.08.002.
  11. Chen MJ, Campbell ST, Finlay AK, Duckworth AD, Bishop JA, Gardner MJ. Surgical and nonoperative management of olecranon fractures in the elderly: a systematic review and meta-analysis. J Orthop Trauma.2021;35(1):10-16. doi: 10.1097/BOT.0000000000001865.
  12. Aibinder WR, Sims LA, Athwal GS, King GJ, Faber KJ. Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients. JSES Int.2021;5(2):291-295. doi: 10.1016/j.jseint.2020.11.001.

 

 

 

The Archives of Bone and Joint Surgery
Volume 14, Issue 7
July 2026
Pages 484-487

  • Receive Date 16 October 2025
  • Revise Date 20 June 2026
  • Accept Date 15 November 2025