Olecranon fractures: do they lead to osteoarthritis? Long-term outcomes and complications.

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Abstract

[Indexed for MEDLINE] 6. J Orthop Trauma. 2023 Nov 1;37(11):e435-e440. doi: 10.1097/BOT.0000000000002672. Effect of Computerized Tomography on Assessment and Surgical Planning for Olecranon Fractures. Hill JR(1)(2), Bechtold DA(1), Gibian JT(1), Kuhn AW(1), Hong Z(1), Tatman LM(1), Aleem AW(1), Berkes MB(1), Zmistowski BM(1). Author information: (1)Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO. (2)Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR. OBJECTIVES: (1) Determine effects of computed tomography (CT) on reproducibility of olecranon fracture classification. (2) Determine effects of CT utilization on interobserver agreement regarding management of olecranon fractures. (3) Evaluate factors associated with articular impaction. METHODS: Seven surgeons retrospectively evaluated radiographs of 46 olecranon fractures. Each fracture was classified according to Colton, Mayo, Orthopaedic Trauma Association/AO Foundation (OTA/AO) systems. Observers determined whether articular impaction was present and provided treatment plans. This was repeated at minimum 6 weeks with addition of CT. Descriptive and comparative statistics were performed and intraclass correlation coefficients (ICCs) were calculated. RESULTS: Interrater agreement was near-perfect for all classifications using radiographs (ICC 0.91, 0.93, 0.89 for Colton, Mayo, OTA/AO) and did not substantially change with CT (ICC 0.91, 0.91, 0.93). Agreement was moderate regarding articular impaction using radiographs (ICC 0.44); this improved significantly with CT (ICC 0.82). Articular impaction was significantly associated with OTA/AO classification, with high prevalence of impaction in OTA/AO 2U1B1e ( P < 0.03). Agreement was substantial for chosen fixation construct using radiographs (ICC 0.71); this improved with CT (ICC 0.79). Utilization of CT changed fixation plans in 25% of cases. Agreement regarding need for void filler was fair using radiographs (ICC 0.37); this notably improved with CT (ICC 0.64). CONCLUSIONS: Utilization of CT for evaluating olecranon fractures led to significant improvements in interobserver agreement for presence of articular impaction. Impaction was significantly associated with fracture pattern, but not with patient-related factors. Addition of CT improved agreement regarding fixation construct and led to notable improvement in agreement regarding need for void filler. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BOT.0000000000002672