Epidemiology and Treatment of Olecranon Fractures: a nationwide register-based analysis of 27,880 cases in Denmark from 1999 to 2018

BACKGROUND: Olecranon fractures (OFs) account for approximately 20% of proximal forearm fractures. Displaced or unstable OFs are typically treated surgically with tension-band wiring (TBW) or plate fixation (PF). While comparative works on surgical OF management exist, epidemiological studies are limited by short time spans and small sample sizes. This study investigates OF incidence rates (IRs), and treatment trends in Denmark over a 20-year period from 1999 to 2018.

PATIENTS AND METHODS: Population-based Danish National Patient Register study on OFs in adult patients from 1999 to 2018. Patients ≥ 20 years diagnosed with OF (ICD-10: S520) were included. Age, sex, and treatment were recorded. Treatment was classified as surgical if relevant surgical procedure codes were recorded within 21 days of OF diagnosis. In the absence of such codes, treatment was classified as non-surgical.

RESULTS: A total of 27,880 OF cases (61% female) were identified between 1999 and 2018. The overall mean IR was 33/100,000/year, increasing from 31 in 1999 to 40 in 2018. Females and males had similar IRs between 20 and 49 years, while females ≥ 50 years showed markedly higher IRs than males. Non-surgical treatment was predominant (67%, range: 64-72%). Surgical treatment was more frequent in females (36%, range: 30-42%) than in males (28%, range: 25-34%) and more frequent in patients ≥ 50 years (37%, range: 32-41%) than in patients < 50 years (24%, range: 22-26). Interestingly, from 2013 onwards, surgical treatment decreased in patients ≥ 70 years. Over time, PF use increased from 7% in 1999 to 45% in 2018. TBW declined from 89% in 1999 to 46% in 2018.

CONCLUSIONS: The incidence of OFs increased by 29% over the 20-year study period. Non-surgical treatment was predominant across all ages but decreased markedly in older patients. Over the assessed two decades, PF increased and TBW decreased in popularity for surgically managed OFs. Studies identifying which patients may benefit most from surgical and non-surgical treatment by incorporating patient-specific factors will help to refine decision-making and optimize clinical outcomes.