Short-term complications of open reduction and internal fixation of olecranon fractures: a national database study

Olecranon fractures comprise ∼10% of upper extremity fractures, often managed with open reduction and internal fixation (ORIF). Despite generally favorable outcomes, short-term complications remain challenging and uncharacterized. This retrospective study aims to address this gap by evaluating short-term complications of olecranon ORIF using a large, nationwide database to determine complication rates and identify associated risk factors.

The American College of Surgeons National Surgical Quality Improvement Program database (2010-2023) was queried for patients undergoing olecranon ORIF (Current Procedural Terminology Code 24685). Demographic, comorbidities, operative variables, and postoperative complications within 30 days were analyzed. Descriptive statistics and multivariate logistic regression were used to identify significant predictors (P < .05).

A total of 8,524 patients (average age 59.4 ± 19.3; 62.3% female) were included. Surgical site infection was amongst the most common singular complications at a rate of 1.8%, with any adverse event reported at a rate of 7.2%. Risk factors included increased age (odds ratio [OR] = 1.03; P < .001), operative time (OR = 1.02; P < .001), blood transfusion (OR = 3.16; P = .001), ascites, and smoking history. Surgical site infection was associated with smoking (OR = 1.66; P = .01) and ascites (OR = 11.38; P = .03).

ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. These findings highlight opportunities for improving care through providing smoking cessation efforts and tailored perioperative management for high-risk patients.