Risk factors for complications and poor function after open reduction and fixation of olecranon fractures

TL;DR

This study identifies that patients needing revision surgeries after olecranon fracture surgery have worse elbow function, but other factors like fracture type or surgical method don't significantly affect outcomes.

Contribution

The study reveals that revisions beyond implant removal are linked to worse function, but no significant associations with fracture type, gender, or surgical method.

Findings

Patients requiring revisions beyond implant removal had significantly worse MEPS scores at follow-up.

No significant differences in functional outcomes or complications were found based on fracture type, gender, or surgical method.

Postoperative joint gap or step-off did not significantly affect functional outcomes.

Abstract

Surgical treatment of olecranon fractures is associated with a high rate of complications, potential restricted elbow function, and the need for revision surgeries. The aim of this study was to evaluate risk factors for complications and reduced functional outcomes following surgical treatment.

All consecutive patients aged ≥18 years and treated at our level 1 trauma center for isolated open and closed olecranon fractures between January 2015 and March 2023 were retrospectively analyzed. Data on epidemiology, comorbidities, fracture type, treatment performed, and complications were collected. To assess elbow function, patients were contacted by phone or mail, and the Oxford Elbow Score, Modified Mayo Elbow Performance Score (MEPS), and Numeric Rating Scale of pain were recorded.

Fifty-two patients (age 47.9 ± 16.5 years, 56% male) were treated during the observation period. According to the AO Foundation/Orthopaedic Trauma Association classification, 61.5% of the cases were classified as type B and the remainder as type C fractures. 94.2% had closed fractures. Two Kirschner wire tension band was performed in 65.4% of patients, while the rest underwent locking plate fixation. The average functional scores were Oxford Elbow Score 42.6 ± 4.9, MEPS 80.1 ± 11.7, and Numeric Rating Scale 1.0 ± 1.5. Postoperative radiographs showed a mean intra-articular gap of 1.5 ± 2.2 mm (min./max. 0.0/11.0 mm) and an intra-articular step-off of 0.5 ± 0.6 mm (min./max. 0.0/2.2 mm). Thirty-one patients (59.6%) underwent a pure implant removal. In 8 patients (15.4%), a revision procedure was necessary, which went beyond just implant removal. These included reosteosynthesis for nonunion or inadequate reduction, arthrolysis, infection débridement, and unspecified revisions possibly related to new trauma. No significant differences were found regarding the need for secondary surgeries, implant removal, revisions, complications, or functional limitations with respect to fracture type, gender (P = .695), surgical procedure (P = .380), or postoperative joint gap/step-off (P = .462/.707). Patients who underwent a revision procedure beyond implant removal had worse function in the MEPS at follow-up (P = .011).

Surgical treatment of olecranon fractures is associated with a high rate of complications, patients undergoing revisions beyond implant removal had poorer functional outcome; however, no significant differences in functional outcomes or secondary operations were found with respect to fracture type, gender, or surgical method. The size of the postoperative joint gap or step-off did not significantly affect the functional outcome. Despite acceptable functional scores, optimizing treatment and patient selection remains essential, as revisions are frequently necessary.

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