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Locked plating system may be safe, effective for olecranon fractures
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NEW YORK — Use of a locked plating system may be safe and effective with an acceptable failure rate in geriatric patients with olecranon fractures, according to results presented here.
Chad Myeroff, MD, and colleagues examined Charleston Comorbidity Index, American Society of Anesthesiologist Score, Mayo radiographic classification, AO classification, range of motion, VAS score, return to the OR and major and minor complications among 36 patients aged 75 years or older who underwent treatment of olecranon fractures with locked plating.
Myeroff noted a union rate of 100% among patients who did not have major complications that resulted in return to the OR. When the four patients who returned to the OR were included, the union rate was 88%, according to Myeroff.
“Looking at our primary outcome, which is major complication, we had an 11% major complication rate,” Myeroff said. “Two of those were deep infection, three were failure fixation and those, overall, occurred in four patients.”
He added seven patients experienced five minor complications, for a minor complication rate of 14%. Myeroff noted patients had good elbow motion and low pain scores, and that 75% of patients who had failure used assisted devices or upper extremity ambulators.
“This may be potentially a cohort we want to be more careful in,” Myeroff said. – by Casey Tingle
Reference:
Wise K, et al. Paper 13. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Myeroff reports no relevant financial disclosures.
Perspective
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Scott P. Steinmann, MD
Previous data from Andrew D. Duckworth, MSc, FRCSEd(Tr&Orth), PhD, of nonoperative fixation of olecranon fractures is of interest in that there may be some lack of extension strength because of a fibrous union or triceps contracture, but the patient avoids potential complications of surgery. If you have an elderly patient who is not in the best health, I think you have to add up the risks of surgery. The data nicely presented by Chad Myeroff, MD, had a combined 10% major complication rate and up to 20% minor complication rate. Many of us have added nonoperative treatment of olecranon fractures as an option we offer to some select patients, which is not something we were doing 10 to 15 years ago. In recent years, the international literature supports surgeons offering nonsurgical treatment of olecranon fractures in the elderly patient.
References:
Duckworth AD, et al. Bone Joint J. 2017;doi:10.1302/0301-620X.99B7.BJJ-2016-1112.R2.
University of Tennessee
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