Articular impaction of olecranon fracture is associated with poor postoperative clinical outcome

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.