Outcomes After Plating of Olecranon Fractures: A Multicenter Evaluation

• Published in: Injury 2016-07, Vol.47 (7), p.1466-1471
• Main Authors: De Giacomo, Anthony F., MD, Tornetta, Paul, MD, Sinicrope, Brent J., MD, Cronin, Patrick K., BS, Althausen, Peter L., MD,MBA, Bray, Timothy J., MD, Kain, Michael S., MD, Marcantonio, Andrew, MD, Sagi, Claude, MD, James, Chris R., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bone Plates; Bone Screws; Elbow Joint - diagnostic imaging; Elbow Joint - injuries; Elbow Joint - physiopathology; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Healing; Fractures, Closed - diagnostic imaging; Fractures, Closed - physiopathology; Fractures, Closed - surgery; Fractures, Comminuted - diagnostic imaging; Fractures, Comminuted - physiopathology; Fractures, Comminuted - surgery; Fractures, Open - diagnostic imaging; Fractures, Open - physiopathology; Fractures, Open - surgery; Functional outcomes; Hardware complications; Humans; Male; Middle Aged; Olecranon fractures; Olecranon Process - diagnostic imaging; Olecranon Process - injuries; Olecranon Process - surgery; Orthopedics; Plating; Radiography; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Treatment Outcome; Ulna Fractures - diagnostic imaging; Ulna Fractures - physiopathology; Ulna Fractures - surgery; United States - epidemiology; Young Adult
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2016.04.015

Abstract Introduction The aim of this study was to report the physical and functional outcomes after open reduction internal fixation of the olecranon in a large series of patients with region specific plating across multiple centers. Patients/Methods Between January 2007 to January 2014, 182 consecutive patients with a displaced olecranon fracture treated with open reduction internal fixation were included in this study. Retrospective review across four trauma centers collected elbow range of motion, DASH scores, hardware complications, and hardware removal. Postoperative visits in the outpatient clinic were at two, six, and twenty-four weeks. After 24 weeks, patients were eligible for hardware removal if symptomatic. All patients were contacted, at least 1 year following surgery, to determine if hardware was removed. Results 182 patients (75 women, 105 men) average age 50 (16–89) with 162 closed and 19 open displaced olecranon fractures were treated with one region specific plate. Nineteen were lost to followup leaving 163 for analysis with all patients united. The most common deficiency was a lack of full extension with 39% lacking at least 10° of extension. Hardware was asymptomatic in 67%, painful upon leaning in 20%, and restricted activities in 11% resulting in a 15% rate of hardware removal. Hardware complaints were more common if a screw was placed in the corner of the plate (P = 0.004). When symptomatic, the area of the plate that was bothersome encompassed the whole plate in 39%, was at the edge of the plate in 33%, and was a screw head in 28%. The DASH scores, collected at final follow-up of 24 weeks, was 10.1 ± 16, indicating moderate disability was still present. Patients who lacked 10° of extension had a DASH of 12.3 as compared with 10.5 for those with near full extension, but this was not significant (P=.5). Conclusion Plating of the olecranon leads to predictable union. The most common complication was lack of full extension with 39% lacking more than 10°, although this did not have any effect on DASH scores. Overall results indicate that disability still exists after 6 months with an average DASH score of 10.