Incidence of post-traumatic osteoarthritis in olecranon fractures and the role of instability and comminution in its development: a systematic review.

In 30 seconds

This systematic review examined post-traumatic ulnohumeral osteoarthritis (OA) after isolated olecranon fractures and whether fracture instability or comminution was associated with its development. Eleven studies included 362 patients, with a median follow-up of 41 months. Median OA incidence was 19% (range: 0%-35%; IQR: 3%-26%). Incidence varied by Mayo fracture type, reaching 50% (range: 40%-100%; IQR: 45%-75%) in displaced, unstable type 3 fractures. Despite radiographic OA, reported elbow outcome scores were generally good to excellent. The authors cautioned that heterogeneous, poor-to-moderate-quality evidence limits conclusions about risk factors.

Key findings

• Across 11 studies and 362 patients, median OA incidence was 19% (range: 0%-35%; IQR: 3%-26%) at a median follow-up of 41 months.
• Median OA incidence was 50% (range: 40%-100%; IQR: 45%-75%) for displaced, unstable Mayo type 3 fractures.
• For type 2 fractures, median OA incidence was 16% in noncomminuted fractures and 24% in comminuted fractures.
• Patients with OA had a median Mayo Elbow Performance Score of 93 (range: 83-94) in the three studies reporting this outcome.

Why it matters

Radiographic OA is a relevant possible outcome after olecranon fracture, particularly in the reported unstable-fracture group. However, the review found generally good-to-excellent functional scores regardless of OA or fracture type. These findings help frame the distinction between radiographic changes and reported elbow function, while highlighting that current evidence does not establish how instability or comminution affects OA risk.

What to keep in mind

The included studies were heterogeneous and of poor-to-moderate methodological quality, so data were not pooled. The review calls for larger, preferably prospective studies to clarify the effects of instability and comminution.