Risk Factors for Loss of Reduction After Open Reduction and Internal Fixation of Isolated Olecranon Fractures in Adults

Abstract

Background: We sought to determine whether any relevant patient, fracture, surgical, or postoperative characteristics are associated with loss of reduction after plate fixation of isolated olecranon fractures in adults. Methods: Patients who underwent open reduction and internal fixation of an olecranon fracture at our institution over an 11-year period were analyzed. Electronic patient charts and radiographic images were reviewed to gather patient, fracture, surgical, and postoperative data. Statistical analysis to explore the differences between groups was performed. Results: Seven of 96 patients experienced a loss of fracture reduction diagnosed at a median of 19 days after their initial surgery (range: 4-116 days). The radiographic mode of failure of all patients who lost reduction was proximal migration of the proximal fracture fragment with or without implant failure. The group that lost reduction had a significantly smaller proximal fragment (14.2 vs 18.6 mm), a higher incidence of malreduction with a persistent articular step-off greater than 2 mm (6/7 vs 14/89), a greater distance between the most proximal screw and the olecranon tip (19.8 vs 13.5 mm), a higher proportion of constructs with screws placed outside of the primary plate (4/7 vs 14/89), and a higher proportion of patients that were not immobilized postoperatively (3/7 vs 8/89). Conclusions: Our results suggest anatomical reduction at the articular surface and adequate fixation of the proximal fragment are key factors in maintenance of reduction, with smaller proximal fragments being at higher risk for failure. A period of postoperative immobilization may decrease the risk of loss of reduction.

Olecranon Fractures

“…In a study of 321 olecranon fractures fixed with precontoured PO, 15.6% patients underwent implant removal 72 . This study has shown that reoperations occur more in young patients and in more complex fractures including Mayo type 3 and Monteggia-like fractures 47,72-74 . Two comparative studies compared different types of PO and showed comparative functional outcomes and reoperations regardless of the type of plate used 30,75-78 .…”

Wedge osteotomy combined with internal fixation in the treatment of Mayo IIB olecranon fractures

“… 4 Forced reduction may result in the formation of “steps” on the articular surface, leading to postoperative traumatic arthritis. 5 In cases with extensive fracture defects, bone resorption at the fractured end can result in nonunion. 6 - 8 Although autogenous bone grafts have the potential to restore ulnar length, their use is limited by the high technical demands involved.…”

Letter to the Editor: Is Tension Band Wire Fixation Superior to Plate Fixation for Simple Displaced Olecranon Fractures? A Randomized Trial With Median Follow-up of 7.5 Years

“…However, the apparent simplicity of the fracture does not equate to uneventful fixation. In my experience, an olecranon fragment of small size, especially in the presence of osteoporosis, may not be adequately stabilized with a plate and screw construct, and this was recently highlighted by Contreras et al [2].…”

“…The extended plate has a long proximal part that curves around the olecranon toward the tip, thereby decreasing the distance between the olecranon tip and the most proximal screw (Fig. 2), which has been shown to reduce loss of reduction [2]. Moreover, the extended proximal part allows insertion of two additional 3.5-mm locking screws which, in a small osteoporotic metaphyseal bone fragment, can greatly enhance fixation [4].…”

“…The three reoperations for infections were preceded by loss of reduction; therefore, these must have occurred in the first few weeks postoperatively. Median time from fixation to the diagnosis of loss of reduction was 19 days in a recent study [2]. Subcutaneous implants may be bothersome early on after surgery, but reoperation to remove them is often delayed up to a year to ensure fracture healing.…”