Olecranon fractures: factors influencing re-operation

Abstract

Purpose: We evaluated factors influencing re-operation in tension band and plating of isolated olecranon fractures.

Methods: Four hundred eighty-nine patients with isolated olecranon fractures who underwent tension band (TB) or open reduction internal fixation (ORIF) from 2003 to 2013 were identified at an urban level 1 trauma centre. Medical records were reviewed for patient information and complications, including infection, nonunion, malunion, loss of function or hardware complication requiring an unplanned surgical intervention. Electronic radiographs of these patients were reviewed to identify Orthopaedic Trauma Association (OTA) fracture classification and patients who underwent TB or ORIF.

Results: One hundred seventy-seven patients met inclusion criteria of isolated olecranon fractures. TB was used for fixation in 43 patients and ORIF in 134. No statistical significance was found when comparing complication rates in open versus closed olecranon fractures. In a multivariate analysis, the key factor in outcome was method of fixation. Overall, there were higher rates of infection and hardware removal in the TB compared with the ORIF group.

Conclusions: Our results demonstrate that the dominant factor driving re-operation in isolated olecranon fractures is type of fixation. When controlling for all variables, there is an increased chance of re-operation in patients with TB fixation.

Figures

Fig. 1

Typical olecranon fracture. Orthopaedic Trauma Association (OTA) classification B1–21

Fig. 2

Olecranon fracture after operative fixation. a Tension band (TB). b Open reduction internal fixation (ORIF). c Screw fixation

Fig. 3

Complications with tension band (TB). a A 77-year-old woman had a ground-level fall. She sustained a 21–B1 closed olecranon fracture, which was treated with TB. She complained of hardware prominence at her first clinic visit. Hardware removal was delayed until postoperative week 8 to allow for union. The single prominent pin was removed, and she went on to union. b An 84-year-old woman fell down stairs. She sustained a 21–B1 closed olecranon fracture, which was treated with TB. On postoperative week 4, she had increased pain and redness at her elbow. X-rays confirmed loss of fixation due to infection. She underwent hardware removal without further fixation