Trends in Operative Fixation of Olecranon Fractures in Elderly Australians: A Nationwide Study From 2000 to 2024

BACKGROUND: Olecranon fractures are a common fragility injury in elderly patients, typically resulting from low-energy mechanisms. While evidence supporting nonoperative management in this population has increased, rates and long-term trends in operative fixation of olecranon fractures in elderly Australians remain poorly characterised. This study evaluated national trends in operative management of olecranon fractures in Australians aged 75 years and older from 2000 to 2024. METHODS: A retrospective analysis of Medicare Benefits Schedule data was performed from 2000 to 2024. Olecranon fracture fixations were identified using item number 47399 (treatment of olecranon fracture by open reduction). Patients aged 75 years and older were included. Annual case volumes and per-capita rates were stratified by year and sex. Temporal trends were assessed using linear regression and correlation analysis. RESULTS: A total of 3,644 olecranon fixation procedures were performed in patients aged 75 years and older. Annual volumes increased over time, reaching 193 procedures in 2024, with a mean annual increase of 3.9 cases (p < 0.001). Female patients accounted for 82.7% of all procedures, though their proportional representation declined 0.45% per year (p < 0.001). Male per-capita fixation rates increased 2.2-fold (r = 0.57; p < 0.01), while female rates remained stable. CONCLUSION: Operative fixation of olecranon fractures in Australians aged 75 years and older increased over the 25-year study period, despite growing evidence supporting nonoperative management in this population. Although female patients accounted for the majority of procedures, their per-capita fixation rates remained stable, while male rates doubled. These findings reflect evolving surgical practice and support further research into patient selection, clinical outcomes and economic implications.