1. Elbow fracture in elderly patient
Case for small group discussion: Upper extremity fractures—decision making and methods of stabilization
AO Trauma Advanced Principles Course

2. 79-year-old man, fell from stairs
Closed
Neurovascular intact
Discussion points:
Discuss classification
Does this fracture need ORIF or arthroplasty due to age and osteoporosis?
If arthroplasty is chosen: total elbow or distal humeral prosthesis?
If ORIF is chosen: Locking plates vs non-locking plates, parallel vs orthogonal plating?
Which surgical approach would be appropriate for ORIF: olecranon osteotomy vs split vs bilateral, chevron vs straight? Point out that osteotomy cannot be done if option to do arthroplasty.
Discuss osteotomy fixation: screws vs K-wires and plate, suture tension band?
Transposition of ulnar nerve?

3. Discussion points:
Preliminary fixation with K-wires?
How should the plate be positioned?
Is it necessary to fill metaphyseal defects?

4. Radial plate maximal distal without impingement with full extension
Discussion points:
What complications could occur?
Discuss postoperative management
Discuss olecranon osteotomy fixation, options

5. 3 months postoperatively
Extension/flexion °
Free pronation or supination, no pain
PDS 1 mm suture tension band has minimal irritation and same construct stability with need for later removal.
Removal is done under local anesthesia and step incision which is impossible with metal wire.
Discussion points:
What are the rehabilitation protocols?
Is postoperative immobilization needed?

6. Summary
Traction for primary reduction before x-rays will enhance the understanding of the fracture pattern
Olecranon osteotomy may be a good surgical approach for an intercondylar fracture
Always identify the ulnar nerve
Absolute stability is required for this fracture to enable early range of motion
Moderator should ask participants to summarize what else they have learned from this case.