Risk factors for symptomatic hardware removal after plate fixation of olecranon fractures: a retrospective chart review

Abstract

Background: Risk factors for removal of symptomatic hardware after plate fixation of olecranon fractures are not well defined. We examined patient, fracture, and surgical characteristics in relation to hardware removal for symptomatic instrumentation after plate and screw fixation of isolated olecranon fractures in adults. Methods: Eighty-four patients who underwent open reduction and internal fixation (ORIF) of isolated olecranon fractures with a plate and screw construct were analyzed retrospectively. Those with subsequent hardware removal for symptomatic hardware were identified. Charts and radiographs were reviewed to gather patient, fracture, and surgical characteristics in relation to management of their olecranon fracture. Univariate analysis was performed to test for statistical significance between groups. Results: Seventeen of 84 patients (20.2%) underwent hardware removal for symptomatic instrumentation at an average of 326 days after ORIF. Compared to patients who retained hardware, those who underwent removal trended younger (40.0 vs. 49.4 yr, P=0.076), had a higher percentage of one particular plate design (35% vs. 8%, P=0.026), and had their plate fixated an average of 1.3 mm farther from the olecranon tip (3.4 vs. 2.1 mm; P=0.011). There was an 8.2 times increased likelihood of hardware removal for plates that were placed more than 2 mm from the olecranon tip [1.7 to 38.7, 95% confidence interval (CI); P=0.003]. Conclusions: This study resulted in approximately 20% rate of symptomatic hardware necessitating removal. Patients who request removal tend to be younger. Fixating the plate closer to the olecranon tip may decrease the incidence of symptomatic hardware and need for subsequent removal. Level of Evidence: Level III.