JSES - 2026-03-13 - Journal Article; Review
Incidence of Post-traumatic Osteoarthritis in Olecranon Fractures and the Role of Instability and Comminution in its Development: A Systematic Review.
Wiersma JP, de Klerk HH, Priester-Vink S, Doornberg JN, Bhasyam AR, van den Bekerom MPJ
Topics
Key Takeaway
Median post-traumatic OA incidence after isolated olecranon fracture is 19% at 41 months, rising to 50% in Mayo Type 3 (unstable) fractures, yet median MEPS remains 92-93 regardless of OA presence.
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Summary
This systematic review quantified OA incidence and its functional impact following isolated olecranon fractures, stratified by Mayo classification. Across 11 studies (n=362), median OA incidence was 19% overall, with Mayo Type 3 (unstable) fractures reaching 50% and comminuted Type 2B fractures reaching 24% versus 16% for non-comminuted Type 2A. Despite radiographic OA, median MEPS was 92–93 (good-to-excellent range), suggesting a disconnect between radiographic and functional outcomes.
Key Limitation
All included studies were of poor-to-moderate MINORS quality with high heterogeneity, making the reported OA incidence ranges (0–100%) too wide to guide specific surgical decision-making.
Original Abstract
BACKGROUND
Olecranon fractures are common fractures of the elbow and may lead to symptomatic post-traumatic osteoarthritis (OA). The incidence and risk factors for ulnohumeral OA after an olecranon fracture remain uncertain. Therefore, this review aimed to: 1) determine the incidence of OA following isolated olecranon fractures; 2) assess the role of instability and comminution in the development of OA, and 3) assess the impact of OA on patient-reported outcome measures (PROMs).
METHODS
Multiple medical databases were searched for studies containing the terms "olecranon", "osteoarthritis", and "fracture". Studies were screened for predetermined inclusion and exclusion criteria, including a minimum follow-up of 24 months and radiographic assessment of OA. Patient and treatment characteristics were collected alongside clinical and functional outcomes. The studies' methodological quality was assessed using the MINORS criteria. The Mayo classification was used to assess olecranon fractures for comminution and instability, categorizing them into three types: type 1 (non-displaced, stable), type 2 (displaced, stable), and type 3 (displaced, unstable). Each type is subdivided into A (non-comminuted) or B (comminuted). Due to a high degree of heterogeneity, pooling of the data was avoided; instead, results were summarized using ranges, medians, and interquartile ranges.
RESULTS
Eleven studies were included, comprising a total of 362 patients with a median follow-up of 41 months (Range: 27-240;
IQR
29-74). The MINORS scores for these studies ranged from poor to moderate. The median OA incidence across these studies was 19% (Range: 0%-35%;
IQR
3%-26%). The median OA incidence was 25% (Range: 0%-50%;
IQR
13%-38%) for Mayo type 1 fractures, 16% (Range: 0%-30%;
IQR
0%-25%) for type 2, and 50% (Range: 40%-100%;
IQR
45%-75%) for type 3. For non-comminuted fractures (type 2A), the median OA incidence was 16% (Range: 0%-28%;
IQR
0%-18%), while for comminuted fractures (type 2B), the median was 24% (Range: 0%-38%;
IQR
17%-30%). Mayo Elbow Performance Score (MEPS) scores for patients with OA were reported in 3 studies with a median score of 93 (Range: 83-94). The median MEPS across all included studies was 92 (Range: 86-98;
IQR
90-96).
CONCLUSION
This review identified a median OA incidence of 19% at a median follow-up of 41 months following isolated olecranon fractures. However, final PROMs ranged from good to excellent regardless of fracture type or the presence of OA. Given that all studies were heterogeneous and of poor to moderate quality, additional larger studies with preferably prospective designs are needed to assess if comminution or instability affects the development of ulnohumeral OA even after appropriate surgical treatment.