Functional results after operative treatment of olecranon fractures

In a retrospective, nonrandomized study, we reviewed our experience with the operative treatment of olecranon fractures to find out which factors correlate with subjective complaints and functional outcome. A total of 95 consecutive olecranon fractures were operatively treated in our level I trauma institution between March 1, 1992 and March 1, 2000. Medical charts and radiographs of all patients were evaluated. Three patients died, 23 were lost to follow-up. Fifty-eight of 69 available patients (84.0%) were reviewed clinically and/or radiologically after a mean time interval of 36 months. Fracture type, fracture classification, associated lesions, technical correctness of osteosynthesis, age and comorbidity were analysed. Radiological end result (intraarticular step-offs, gaps, arthrosis), subjective complaints, mobility of the elbow joint and muscle strength were evaluated. Patients with an unstable elbow (Mayo classification type III and Schatzker-Schmeling classification type D) had a higher loss of elbow function than others. There was a correlation between fracture morphology (fractures type C and D in the Schatzker-Schmeling classification) and arthrosis. There also was a correlation between suboptimal osteosynthesis and arthrosis. There was no correlation between suboptimal osteosynthesis, implant loosening and secondary procedures. Patients more often expressed subjective complaints and loss of function in activities of daily life before than after hardware removal. Primary elbow instability and fracture morphology are prognostic factors for elbow function and development of arthrosis after operative treatment of olecranon fractures. We therefore recommend the classification systems of the Mayo-clinic or of Schatzker-Schmeling. As many patients have complaints related to the implants, we recommend hardware removal after fracture healing.