Complications Associated with Surgical Management of Olecranon Fractures: A Systematic Review

The purpose of this study was to systematically review the literature to assess surgical complications following surgical management of olecranon fractures.

A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies reporting complications following olecranon fracture management were included. The complication profile of plate fixation (PF), screw fixation, and tension band wiring (TBW) was recorded. Implant removal rates were considered independent of complication rates.

Eighty-six studies were included in the analysis, with 5,161 patients who underwent an olecranon fracture treatment with an average age of 50.2 years (range, 7.4-88.8) and an average follow-up of 30.8 months (range, 3-218). The majority of studies used PF (58.1%). Screw fixation had higher implant complications than PF (5.9% vs 3.0%, p < 0.001), and PF had the highest percentage of musculoskeletal complications (3.6%, p <0.001) and wound complications (4.8%, p = 0.048). Nerve complications were similar among the 3 surgical options (p = 0.233). PF had the lowest complication rate (12.6%, p < 0.001), while screw fixation had the lowest reoperation (8.6%, p < 0.001) and implant removal rates (6.2%, p < 0.001). The overall complication rate for TBW was 18.4%, with loss of reduction being the most common complications occurring in 2.8% of patients.

PF demonstrated lower overall complications compared with screw fixation, with increased rates of symptomatic implants requiring removal which contributed to higher reoperation rates. TBW demonstrated an inferior complication profile compared with both modern fixation options. Further research should expand on the limited comparative studies between screw and PF.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.