Risk Factors for 30-Day Postoperative Complications Following Open Reduction Internal Fixation of Proximal Ulna Fractures.
OBJECTIVE
Fractures of the proximal ulna are common injuries in the elderly population. These fractures can be managed nonsurgically or with open reduction internal fixation (ORIF). Whereas nonsurgical management may lead to a relative loss of elbow extension and to nonunion, ORIF carries a risk of complications. Although complications specific to the orthopedic intervention have been reported, few studies have identified postoperative systemic complications in this higher-risk group. The purposes of this study were to determine the rate of systemic complications in patients undergoing surgical fixation of proximal ulna fractures and to determine risk factors for complications.


METHODS
We queried the American College of Surgeons National Surgical Quality Improvement Program database for all cases of proximal ulna fracture ORIF between 2005 and 2013. Demographic, historical, and preoperative laboratory data and 30-day postoperative complications were recorded. Univariate and multivariable analyses were performed to identify independent risk factors for complications.


RESULTS
A total of 650 patients met inclusion criteria. Within the 30-day postoperative period, 61 complications occurred in 45 patients (6.9%). Return to the operating room, which occurred in 19 patients (2.9%), was the most common major morbidity. American Society of Anesthesiologists class III or IV and dialysis dependence were independent risk factors for any complication.


CONCLUSIONS
Proximal ulna fracture ORIF has a low rate of systemic complications. The most common morbidities are return to the operating room, blood transfusion, and urinary tract infections. Dialysis and American Society of Anesthesiologists class III or IV are independent risk factors for complications. These complications may be nonspecific and related more to the patient population than procedure. We believe that the relatively low risk of short-term complications makes operative treatment a suitable option even in elderly patients with multiple morbidities.


METHODS
Prognostic II.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Nikunj N
NN
Trivedi
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Matthew R
MR
Cohn
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Samir K
SK
Trehan
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. Electronic address: daluiskia@hss.edu.
Aaron
A
Daluiski
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000092464:Elbow Injuries
Complications; National Surgical Quality Improvement Program; elbow; open reduction internal fixation; proximal ulna fracture