Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients.
Elbow fracture
Elbow injury
Olecranon fracture
Plate fixation
Risk factors
Tension band wiring
Journal
JSES international
ISSN: 2666-6383
Titre abrégé: JSES Int
Pays: United States
ID NLM: 101763461
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
entrez:
10
9
2021
pubmed:
11
9
2021
medline:
11
9
2021
Statut:
epublish
Résumé
High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures. Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built. After the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% ( Surgeons preferred to use PF in younger patients and multifragmented fractures. Patients should be counseled that secondary surgery is common after surgical fixation of olecranon fractures. Symptomatic hardware removal was the most frequently reported reason for secondary surgery and more frequent after TBW. When using TBW, intramedullary K-wire positioning should be avoided. The rate of major complications leading to secondary surgery was similar in the TBW and PF groups. Overall, the risk of subsequent secondary surgery was higher in younger patients and patients treated with TBW.
Sections du résumé
BACKGROUND
BACKGROUND
High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures.
METHODS
METHODS
Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built.
RESULTS
RESULTS
After the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% (
CONCLUSION
CONCLUSIONS
Surgeons preferred to use PF in younger patients and multifragmented fractures. Patients should be counseled that secondary surgery is common after surgical fixation of olecranon fractures. Symptomatic hardware removal was the most frequently reported reason for secondary surgery and more frequent after TBW. When using TBW, intramedullary K-wire positioning should be avoided. The rate of major complications leading to secondary surgery was similar in the TBW and PF groups. Overall, the risk of subsequent secondary surgery was higher in younger patients and patients treated with TBW.
Identifiants
pubmed: 34505111
doi: 10.1016/j.jseint.2021.04.014
pii: S2666-6383(21)00132-8
pmc: PMC8411052
doi:
Types de publication
Journal Article
Langues
eng
Pagination
948-953Informations de copyright
© 2021 The Author(s).
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