Treffer: Articular impaction of olecranon fracture is associated with poor postoperative clinical outcome.
Title:
Articular impaction of olecranon fracture is associated with poor postoperative clinical outcome.
Authors:
Kim KE; Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea., Sung SY; Department of Orthopedic Surgery, College of Medicine, Catholic-Kwandong University, Seoul, South Korea., Lee YS; Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea., Park TH; Department of Orthopedic Surgery, Gangnam Nanoori Hospital, Seoul, South Korea., Lee EJ; Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, South Korea., Jeon SY; Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, South Korea., Kim JS; Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea.
Source:
The bone & joint journal [Bone Joint J] 2026 Jan 01; Vol. 108-B (1), pp. 109-117. Date of Electronic Publication: 2026 Jan 01.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: British Editorial Society of Bone & Joint Surgery Country of Publication: England NLM ID: 101599229 Publication Model: Electronic Cited Medium: Internet ISSN: 2049-4408 (Electronic) Linking ISSN: 20494394 NLM ISO Abbreviation: Bone Joint J Subsets: MEDLINE
Imprint Name(s):
Original Publication: London : British Editorial Society of Bone & Joint Surgery
MeSH Terms:
Olecranon Process*/injuries , Olecranon Process*/surgery , Olecranon Process*/diagnostic imaging , Ulna Fractures*/surgery , Ulna Fractures*/diagnostic imaging , Fracture Fixation, Internal*/methods , Open Fracture Reduction*/methods, Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Range of Motion, Articular ; Aged ; Adult ; Treatment Outcome ; Tomography, X-Ray Computed ; Postoperative Complications ; Elbow Joint/surgery ; Elbow Joint/diagnostic imaging ; Elbow Joint/physiopathology ; Olecranon Fracture
References:
Parkes J , Limb R , Quadri ST , et al. Complications and mortality associated with olecranon fractures in the elderly: a retrospective cohort comparison from a large level one trauma centre . Shoulder Elbow . 2022 ; 14 ( 2 ): 200 – 210 . 10.1177/1758573221994860 35265187.
Powell AJ , Farhan-Alanie OM , Bryceland JK , Nunn T . The treatment of olecranon fractures in adults . Musculoskelet Surg . 2017 ; 101 ( 1 ): 1 – 9 . 10.1007/s12306-016-0449-5 28050809.
Newman SDS , Mauffrey C , Krikler S . Olecranon fractures . Injury . 2009 ; 40 ( 6 ): 575 – 581 . 10.1016/j.injury.2008.12.013 19394931.
Duckworth AD , Carter TH , Chen MJ , Gardner MJ , Watts AC . Olecranon fractures: current treatment concepts . Bone Joint J . 2023 ; 105-B ( 2 ): 112 – 123 . 10.1302/0301-620X.105B2.BJJ-2022-0703.R1 36722062.
Schatzker J , Tile M . The Rationale of Operative Fracture Care . 3rd ed . Springer , 2005 .
Jung K-H , Jang S-M , Lee H-J , Park K-B , Ahn J-W , Oh S-H . Anatomical reduction of marginal impaction in posterior wall acetabular fractures ensures mid-term satisfactory outcomes . Sci Rep . 2025 ; 15 ( 1 ): 23848 . 10.1038/s41598-025-09487-w 40615472.
Giannoudis PV , Kanakaris NK , Delli Sante E , Morell DJ , Stengel D , Prevezas N . Acetabular fractures with marginal impaction: mid-term results . Bone Joint J . 2013 ; 95-B ( 2 ): 230 – 238 . 10.1302/0301-620X.95B2.30548 23365034.
Oh HK , Choo SK , Lee CS , Song JG . Operative treatment of communited olecranon fractures using tension-band wiring and miniplate augmentation . Orthopedics . 2013 ; 36 ( 4 ): 275 – 278 . 10.3928/01477447-20130327-03 23590768.
Cho JW , Oh JK , Um J , Sohn HS . Outcomes of embedded rafting k-wire technique for intermediate articular fragment fixation in comminuted olecranon fractures . Arch Orthop Trauma Surg . 2022 ; 142 ( 11 ): 3327 – 3334 . 10.1007/s00402-021-04166-7 34554312.
Okamoto M , Namba J , Kuriyama K , Miyamura S , Yokoi H , Yamamoto K . Surgical technique in tension band wiring method for selected comminuted olecranon fractures . Eur J Orthop Surg Traumatol . 2020 ; 30 ( 2 ): 237 – 242 . 10.1007/s00590-019-02551-y 31538271.
Carter TH , Molyneux SG , Reid JT , White TO , Duckworth AD . Tension-band wire fixation of olecranon fractures . JBJS Essent Surg Tech . 2018 ; 8 ( 3 ): e22 . 10.2106/JBJS.ST.17.00071 30588367.
Lee SH , Kim MB , Lee YH , Kang HJ . Reduction of olecranon fractures with no or minimal dorsal cortex comminution based on the contour of the posterior ulnar cortex: does it restore the greater sigmoid notch? Arch Orthop Trauma Surg . 2022 ; 142 ( 9 ): 2215 – 2224 . 10.1007/s00402-021-03934-9 34014334.
Müller ME , Allgöwer M , Schneider R . Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group . Berlin : Springer , 1991 .
Veillette CJH , Steinmann SP . Olecranon fractures . Orthop Clin North Am . 2008 ; 39 ( 2 ): 229 – 236 , . 10.1016/j.ocl.2008.01.002 18374813.
Kim MB , Lee SH , Lee JH , Yang H . Arc centre distance change after treatment of complex transverse olecranon fractures with a large impacted articular fragment treated with tension band wiring and bone graft . J Hand Surg Asian-Pac Vol . 2022 ; 27 ( 04 ): 623 – 635 . 10.1142/S242483552250059X 35965369.
Tarallo L , Mugnai R , Adani R , Capra F , Zambianchi F , Catani F . Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques . Arch Orthop Trauma Surg . 2014 ; 134 ( 8 ): 1107 – 1114 . 10.1007/s00402-014-2021-9 24935660.
Ren Y-M , Qiao H-Y , Wei Z-J , et al. Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis . J Orthop Surg Res . 2016 ; 11 ( 1 ): 137 . 10.1186/s13018-016-0465-z 27842568.
Hudak PL , Amadio PC , Bombardier C , et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head) . Am J Ind Med . 1996 ; 29 ( 6 ): 602 – 608 . 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L 8773720.
Gummesson C , Atroshi I , Ekdahl C . The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery . BMC Musculoskelet Disord . 2003 ; 4 : 11 . 10.1186/1471-2474-4-11 12809562.
Morrey BF , Adams RA . Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow . J Bone Joint Surg Am . 1992 ; 74-A ( 4 ): 479 – 490 . 1583042.
Morrey BF , An K , Chao E . Functional evaluation of the elbow . In : Morley BF . ed . Morrey’s the Elbow and Its Disorders . WB Saunders , 1993 .
Broberg MA , Morrey BF . Results of delayed excision of the radial head after fracture . J Bone Joint Surg Am . 1986 ; 68-A ( 5 ): 669 – 674 . 3722222.
Meesters AML , Ten Duis K , Kraeima J , et al. The accuracy of gap and step-off measurements in acetabular fracture treatment . Sci Rep . 2021 ; 11 ( 1 ): 18294 . 10.1038/s41598-021-97837-9 34521962.
Baecher N , Edwards S . Olecranon fractures . J Hand Surg Am . 2013 ; 38 ( 3 ): 593 – 604 . 10.1016/j.jhsa.2012.12.036 23428192.
Hill JR , Bechtold DA , Gibian JT , et al. Effect of computerized tomography on assessment and surgical planning for olecranon fractures . J Orthop Trauma . 2023 ; 37 ( 11 ): e435 – e440 . 10.1097/BOT.0000000000002672 37482630.
Martins e Souza P , Giordano V , Goldsztajn F , Siciliano AAO , Grizendi JA , Dias MV . Marginal impaction in posterior wall fractures of the acetabulum . AJR Am J Roentgenol . 2015 ; 204 ( 4 ): W470 – 4 . 10.2214/AJR.14.12451 25794097.
Hackl M , Lappen S , Neiss WF , Scaal M , Müller LP , Wegmann K . The bare area of the proximal ulna: An anatomical study on optimizing olecranon osteotomy . Orthopade . 2016 ; 45 ( 10 ): 887 – 894 . 10.1007/s00132-016-3332-z 27600569[Article in German].
Seo J , Yang KH , Shim DW , Cho H , Park YC . Marginal impaction associated with posterior malleolar fracture in rotational ankle injury . Injury . 2022 ; 53 ( 2 ): 756 – 761 . 10.1016/j.injury.2021.12.013 34924191.
Matta JM . Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective . Clin Orthop Relat Res . 1994 ; 305 ( 305 ): 10 – 19 . 10.1097/00003086-199408000-00003 8050218.
Shrout PE , Fleiss JL . Intraclass correlations: uses in assessing rater reliability . Psychol Bull . 1979 ; 86 ( 2 ): 420 – 428 . 10.1037//0033-2909.86.2.420 18839484.
Ring D , Jupiter JB . Fracture-dislocation of the elbow . J Bone Joint Surg Am . 1998 ; 80-A ( 4 ): 566 – 580 . 9563387.
Doornberg J , Ring D , Jupiter JB . Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch . Clin Orthop Relat Res . 2004 ; 429 ( 429 ): 292 – 300 . 10.1097/01.blo.0000142627.28396.cb 15577501.
von Rüden C , Woltmann A , Hierholzer C , Trentz O , Bühren V . The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures . J Orthop Surg Res . 2011 ; 6 ( 1 ): 9 . 10.1186/1749-799X-6-9 21310049.
Suresh SS . Management of comminuted olecranon fractures with precut K-wires and tension band wiring . Tech Hand Up Extrem Surg . 2009 ; 13 ( 2 ): 82 – 84 . 10.1097/BTH.0b013e31819225dc 19516132.
Cook E , James S , Watts AC , The SOFFT team . A randomized controlled trial to compare clinical and cost-effectiveness of suture fixation versus tension band wiring for simple olecranon fracture fixation in adults: the Simple Olecranon Fracture Fixation Trial (SOFFT) protocol . Bone Jt Open . 2023 ; 4 ( 1 ): 27 – 37 . 10.1302/2633-1462.41.BJO-2022-0132.R1 36641631.
Esper GW , Herbosa CG , Moses MJ , Egol KA . Comminuted olecranon fractures (Mayo IIB): is dynamic tension band wiring enough? J Orthop Trauma . 2023 ; 37 ( 2 ): 96 – 101 . 10.1097/BOT.0000000000002474 36658697.
Wadhwa H , Goodnough LH , Finlay AK , et al. Incidence and management of articular impaction in geriatric olecranon fractures . J Am Acad Orthop Surg . 2021 ; 29 ( 18 ): 805 – 810 . 10.5435/JAAOS-D-20-01293 33999874.
Giannoudis PV , Tzioupis C , Papathanassopoulos A , Obakponovwe O , Roberts C . Articular step-off and risk of post-traumatic osteoarthritis. Evidence today . Injury . 2010 ; 41 ( 10 ): 986 – 995 . 10.1016/j.injury.2010.08.003 20728882.
Verbeek DO , van der List JP , Villa JC , Wellman DS , Helfet DL . Postoperative CT is superior for acetabular fracture reduction assessment and reliably predicts hip survivorship . J Bone Joint Surg Am . 2017 ; 99-A ( 20 ): 1745 – 1752 . 10.2106/JBJS.16.01446 29040129.
Tannast M , Najibi S , Matta JM . Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures . J Bone Joint Surg Am . 2012 ; 94-A ( 17 ): 1559 – 1567 . 10.2106/JBJS.K.00444 22992846.
Bhandari M , Matta J , Ferguson T , Matthys G . Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip . J Bone Joint Surg Br . 2006 ; 88-B ( 12 ): 1618 – 1624 . 10.1302/0301-620X.88B12.17309 17159175.
Franchignoni F , Vercelli S , Giordano A , Sartorio F , Bravini E , Ferriero G . Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH) . J Orthop Sports Phys Ther . 2014 ; 44 ( 1 ): 30 – 39 . 10.2519/jospt.2014.4893 24175606.
Sun Z , Li J , Luo G , Wang F , Hu Y , Fan C . What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis? Bone Joint J . 2021 ; 103-B ( 2 ): 366 – 372 . 10.1302/0301-620X.103B2.BJJ-2020-0259.R3 33517717.
Powell AJ , Farhan-Alanie OM , Bryceland JK , Nunn T . The treatment of olecranon fractures in adults . Musculoskelet Surg . 2017 ; 101 ( 1 ): 1 – 9 . 10.1007/s12306-016-0449-5 28050809.
Newman SDS , Mauffrey C , Krikler S . Olecranon fractures . Injury . 2009 ; 40 ( 6 ): 575 – 581 . 10.1016/j.injury.2008.12.013 19394931.
Duckworth AD , Carter TH , Chen MJ , Gardner MJ , Watts AC . Olecranon fractures: current treatment concepts . Bone Joint J . 2023 ; 105-B ( 2 ): 112 – 123 . 10.1302/0301-620X.105B2.BJJ-2022-0703.R1 36722062.
Schatzker J , Tile M . The Rationale of Operative Fracture Care . 3rd ed . Springer , 2005 .
Jung K-H , Jang S-M , Lee H-J , Park K-B , Ahn J-W , Oh S-H . Anatomical reduction of marginal impaction in posterior wall acetabular fractures ensures mid-term satisfactory outcomes . Sci Rep . 2025 ; 15 ( 1 ): 23848 . 10.1038/s41598-025-09487-w 40615472.
Giannoudis PV , Kanakaris NK , Delli Sante E , Morell DJ , Stengel D , Prevezas N . Acetabular fractures with marginal impaction: mid-term results . Bone Joint J . 2013 ; 95-B ( 2 ): 230 – 238 . 10.1302/0301-620X.95B2.30548 23365034.
Oh HK , Choo SK , Lee CS , Song JG . Operative treatment of communited olecranon fractures using tension-band wiring and miniplate augmentation . Orthopedics . 2013 ; 36 ( 4 ): 275 – 278 . 10.3928/01477447-20130327-03 23590768.
Cho JW , Oh JK , Um J , Sohn HS . Outcomes of embedded rafting k-wire technique for intermediate articular fragment fixation in comminuted olecranon fractures . Arch Orthop Trauma Surg . 2022 ; 142 ( 11 ): 3327 – 3334 . 10.1007/s00402-021-04166-7 34554312.
Okamoto M , Namba J , Kuriyama K , Miyamura S , Yokoi H , Yamamoto K . Surgical technique in tension band wiring method for selected comminuted olecranon fractures . Eur J Orthop Surg Traumatol . 2020 ; 30 ( 2 ): 237 – 242 . 10.1007/s00590-019-02551-y 31538271.
Carter TH , Molyneux SG , Reid JT , White TO , Duckworth AD . Tension-band wire fixation of olecranon fractures . JBJS Essent Surg Tech . 2018 ; 8 ( 3 ): e22 . 10.2106/JBJS.ST.17.00071 30588367.
Lee SH , Kim MB , Lee YH , Kang HJ . Reduction of olecranon fractures with no or minimal dorsal cortex comminution based on the contour of the posterior ulnar cortex: does it restore the greater sigmoid notch? Arch Orthop Trauma Surg . 2022 ; 142 ( 9 ): 2215 – 2224 . 10.1007/s00402-021-03934-9 34014334.
Müller ME , Allgöwer M , Schneider R . Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group . Berlin : Springer , 1991 .
Veillette CJH , Steinmann SP . Olecranon fractures . Orthop Clin North Am . 2008 ; 39 ( 2 ): 229 – 236 , . 10.1016/j.ocl.2008.01.002 18374813.
Kim MB , Lee SH , Lee JH , Yang H . Arc centre distance change after treatment of complex transverse olecranon fractures with a large impacted articular fragment treated with tension band wiring and bone graft . J Hand Surg Asian-Pac Vol . 2022 ; 27 ( 04 ): 623 – 635 . 10.1142/S242483552250059X 35965369.
Tarallo L , Mugnai R , Adani R , Capra F , Zambianchi F , Catani F . Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques . Arch Orthop Trauma Surg . 2014 ; 134 ( 8 ): 1107 – 1114 . 10.1007/s00402-014-2021-9 24935660.
Ren Y-M , Qiao H-Y , Wei Z-J , et al. Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis . J Orthop Surg Res . 2016 ; 11 ( 1 ): 137 . 10.1186/s13018-016-0465-z 27842568.
Hudak PL , Amadio PC , Bombardier C , et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head) . Am J Ind Med . 1996 ; 29 ( 6 ): 602 – 608 . 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L 8773720.
Gummesson C , Atroshi I , Ekdahl C . The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery . BMC Musculoskelet Disord . 2003 ; 4 : 11 . 10.1186/1471-2474-4-11 12809562.
Morrey BF , Adams RA . Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow . J Bone Joint Surg Am . 1992 ; 74-A ( 4 ): 479 – 490 . 1583042.
Morrey BF , An K , Chao E . Functional evaluation of the elbow . In : Morley BF . ed . Morrey’s the Elbow and Its Disorders . WB Saunders , 1993 .
Broberg MA , Morrey BF . Results of delayed excision of the radial head after fracture . J Bone Joint Surg Am . 1986 ; 68-A ( 5 ): 669 – 674 . 3722222.
Meesters AML , Ten Duis K , Kraeima J , et al. The accuracy of gap and step-off measurements in acetabular fracture treatment . Sci Rep . 2021 ; 11 ( 1 ): 18294 . 10.1038/s41598-021-97837-9 34521962.
Baecher N , Edwards S . Olecranon fractures . J Hand Surg Am . 2013 ; 38 ( 3 ): 593 – 604 . 10.1016/j.jhsa.2012.12.036 23428192.
Hill JR , Bechtold DA , Gibian JT , et al. Effect of computerized tomography on assessment and surgical planning for olecranon fractures . J Orthop Trauma . 2023 ; 37 ( 11 ): e435 – e440 . 10.1097/BOT.0000000000002672 37482630.
Martins e Souza P , Giordano V , Goldsztajn F , Siciliano AAO , Grizendi JA , Dias MV . Marginal impaction in posterior wall fractures of the acetabulum . AJR Am J Roentgenol . 2015 ; 204 ( 4 ): W470 – 4 . 10.2214/AJR.14.12451 25794097.
Hackl M , Lappen S , Neiss WF , Scaal M , Müller LP , Wegmann K . The bare area of the proximal ulna: An anatomical study on optimizing olecranon osteotomy . Orthopade . 2016 ; 45 ( 10 ): 887 – 894 . 10.1007/s00132-016-3332-z 27600569[Article in German].
Seo J , Yang KH , Shim DW , Cho H , Park YC . Marginal impaction associated with posterior malleolar fracture in rotational ankle injury . Injury . 2022 ; 53 ( 2 ): 756 – 761 . 10.1016/j.injury.2021.12.013 34924191.
Matta JM . Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective . Clin Orthop Relat Res . 1994 ; 305 ( 305 ): 10 – 19 . 10.1097/00003086-199408000-00003 8050218.
Shrout PE , Fleiss JL . Intraclass correlations: uses in assessing rater reliability . Psychol Bull . 1979 ; 86 ( 2 ): 420 – 428 . 10.1037//0033-2909.86.2.420 18839484.
Ring D , Jupiter JB . Fracture-dislocation of the elbow . J Bone Joint Surg Am . 1998 ; 80-A ( 4 ): 566 – 580 . 9563387.
Doornberg J , Ring D , Jupiter JB . Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch . Clin Orthop Relat Res . 2004 ; 429 ( 429 ): 292 – 300 . 10.1097/01.blo.0000142627.28396.cb 15577501.
von Rüden C , Woltmann A , Hierholzer C , Trentz O , Bühren V . The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures . J Orthop Surg Res . 2011 ; 6 ( 1 ): 9 . 10.1186/1749-799X-6-9 21310049.
Suresh SS . Management of comminuted olecranon fractures with precut K-wires and tension band wiring . Tech Hand Up Extrem Surg . 2009 ; 13 ( 2 ): 82 – 84 . 10.1097/BTH.0b013e31819225dc 19516132.
Cook E , James S , Watts AC , The SOFFT team . A randomized controlled trial to compare clinical and cost-effectiveness of suture fixation versus tension band wiring for simple olecranon fracture fixation in adults: the Simple Olecranon Fracture Fixation Trial (SOFFT) protocol . Bone Jt Open . 2023 ; 4 ( 1 ): 27 – 37 . 10.1302/2633-1462.41.BJO-2022-0132.R1 36641631.
Esper GW , Herbosa CG , Moses MJ , Egol KA . Comminuted olecranon fractures (Mayo IIB): is dynamic tension band wiring enough? J Orthop Trauma . 2023 ; 37 ( 2 ): 96 – 101 . 10.1097/BOT.0000000000002474 36658697.
Wadhwa H , Goodnough LH , Finlay AK , et al. Incidence and management of articular impaction in geriatric olecranon fractures . J Am Acad Orthop Surg . 2021 ; 29 ( 18 ): 805 – 810 . 10.5435/JAAOS-D-20-01293 33999874.
Giannoudis PV , Tzioupis C , Papathanassopoulos A , Obakponovwe O , Roberts C . Articular step-off and risk of post-traumatic osteoarthritis. Evidence today . Injury . 2010 ; 41 ( 10 ): 986 – 995 . 10.1016/j.injury.2010.08.003 20728882.
Verbeek DO , van der List JP , Villa JC , Wellman DS , Helfet DL . Postoperative CT is superior for acetabular fracture reduction assessment and reliably predicts hip survivorship . J Bone Joint Surg Am . 2017 ; 99-A ( 20 ): 1745 – 1752 . 10.2106/JBJS.16.01446 29040129.
Tannast M , Najibi S , Matta JM . Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures . J Bone Joint Surg Am . 2012 ; 94-A ( 17 ): 1559 – 1567 . 10.2106/JBJS.K.00444 22992846.
Bhandari M , Matta J , Ferguson T , Matthys G . Predictors of clinical and radiological outcome in patients with fractures of the acetabulum and concomitant posterior dislocation of the hip . J Bone Joint Surg Br . 2006 ; 88-B ( 12 ): 1618 – 1624 . 10.1302/0301-620X.88B12.17309 17159175.
Franchignoni F , Vercelli S , Giordano A , Sartorio F , Bravini E , Ferriero G . Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH) . J Orthop Sports Phys Ther . 2014 ; 44 ( 1 ): 30 – 39 . 10.2519/jospt.2014.4893 24175606.
Sun Z , Li J , Luo G , Wang F , Hu Y , Fan C . What constitutes a clinically important change in Mayo Elbow Performance Index and range of movement after open elbow arthrolysis? Bone Joint J . 2021 ; 103-B ( 2 ): 366 – 372 . 10.1302/0301-620X.103B2.BJJ-2020-0259.R3 33517717.
Entry Date(s):
Date Created: 20251231 Date Completed: 20251231 Latest Revision: 20251231
Update Code:
20260101
DOI:
10.1302/0301-620X.108B1.BJJ-2025-0444.R1
PMID:
41475364
Database:
MEDLINE
Weitere Informationen
Aims: Articular impaction in olecranon fractures has been under-recognized. This study aimed to evaluate the clinical implications of articular impaction, and to identify factors associated with poor postoperative outcomes following open reduction and internal fixation (ORIF).
Methods: Patients who underwent ORIF for olecranon fractures were retrospectively reviewed. Articular impaction was assessed using preoperative CT scans, and articular impaction reduction quality was categorized based on residual depression. Functional outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and range of motion. Multivariable regression analysis was performed to identify independent predictors of poor outcomes.
Results: Of 122 patients with olecranon fractures, 41 (33.6%) demonstrated articular impaction on CT. Patients with articular impaction exhibited significantly worse functional outcomes, including higher DASH scores (p = 0.018), lower MEPS (p = 0.021), and increased incidence of post-traumatic arthritis (p = 0.048). In the total cohort, step-off > 2 mm was the only independent predictor of poor outcomes (adjusted odds ratio (OR) 12.338 (95% CI 3.082 to 49.391); p < 0.001). Within the impaction group, both step-off > 2 mm (adjusted OR 5.793 (95% CI 2.954 to 8.524); p < 0.01) and poor impaction reduction (> 3 mm residual depression) (adjusted OR 5.487 (95% CI 1.313 to 731.824); p = 0.033) were significant predictors of worse functional outcome.
Conclusion: Articular impaction in olecranon fractures is associated with worse postoperative outcomes, with inadequate impaction reduction contributing to increased step-off and poorer function. Achieving optimal impaction reduction and minimizing residual step-off are critical to improving clinical and radiological outcome.
(© 2026 The British Editorial Society of Bone & Joint Surgery.)
None declared.