Olecranon Fracture Hardware Removal Trends in Plate and Screw vs Other Methods: A TriNetX Database Review of 2594 Patients

Objectives There are several operative strategies employed for the olecranon fractures, including plate and screw fixation and tension-banding, with controversy persisting around which has potentially has a higher rate of hardware irritation warranting removal of hardware. The study hypothesis is that neither construct has a higher hardware removal rate than the other. Methods The TriNetX US Collaborative Network was queried for all patients diagnosed with displaced fractures of the olecranon process from 2017 to 2022. Cohorts were defined by International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes, and patients were split into “plate and screw” vs “other fixation method” groups. Statistical analysis with two-sided t-tests was performed to compare incidence between groups, and a Z-test was used for comparing proportions. Results Rates of hardware removal did not significantly change from 2017 to 2022, with a total rate of hardware removal of 20%. Plate and screw fixation comprised 46% of operations, while other fixation methods comprised 54% of operations. Use of plate and screw significantly increased from (36% v 48%, P<0.001), while use of other fixation methods significantly decreased from (64% v 54%, P<0.005). Conclusion The study hypothesis was upheld, with no significant difference in hardware removal rates identified between olecranon fixation methods. These findings confirm a meaningful high hardware removal rate of 20%, but suggest comparable hardware irritation potential irrespective of treatment strategy. The choice of implant should be based on the best fixation construct, with less consideration given to potential hardware removal needs.