Olecranon fractures comprise ∼10% of upper extremity fractures, often managed with open reduction and internal fixation (ORIF). Despite generally favorable outcomes, short-term complications remain challenging and uncharacterized. This retrospective study aims to address this gap by evaluating short-term complications of olecranon ORIF using a large, nationwide database to determine complication rates and identify associated risk factors. The American College of Surgeons National Surgical Quality Improvement Program database (2010-2023) was queried for patients undergoing olecranon ORIF (Current Procedural Terminology Code 24685). Demographic, comorbidities, operative variables, and postoperative complications within 30 days were analyzed. Descriptive statistics and multivariate logistic regression were used to identify significant predictors (P < .05). A total of 8,524 patients (average age 59.4 ± 19.3; 62.3% female) were included. Surgical site infection was amongst the most common singular complications at a rate of 1.8%, with any adverse event reported at a rate of 7.2%. Risk factors included increased age (odds ratio [OR] = 1.03; P < .001), operative time (OR = 1.02; P < .001), blood transfusion (OR = 3.16; P = .001), ascites, and smoking history. Surgical site infection was associated with smoking (OR = 1.66; P = .01) and ascites (OR = 11.38; P = .03). ORIF for olecranon fractures demonstrates low short-term complication rates; however, specific comorbidities such as smoking and ascites were associated with increased risk. These findings highlight opportunities for improving care through providing smoking cessation efforts and tailored perioperative management for high-risk patients.

Objective: This study’s purpose was to compare clinical outcomes in adult patients who underwent dual plate versus single plate fixation for humerus fractures to enhance decision-making and patient care. Methods: Data sources : A pre-registered systematic review and meta-analysis searched four databases on January 9th, 2025. Inclusion criteria were studies that compared dual versus single plate fixation for humerus fractures. Outcomes included risk of nonunion, risk of total complications, and time until union after surgery. A random effects meta-analysis was done using risk ratio (RR) or unstandardized mean difference. Results: Thirteen moderate quality retrospective studies were included out of 211 articles retrieved. Patients ( n = 788; 47.8% male) had an average age of 50.4 ± 14.2 years and an average follow-up time of 18.1 ± 14.4 months with 378 patients (48.0%) receiving dual plate fixation and 410 patients (52.0%) receiving single plate fixation for humerus fracture (38.4% distal humerus; 61.7% humeral shaft). There was no statistically significant difference in risk of nonunion between dual and single plate fixation groups ( p = 0.502; RR: 0.99; 5.0% vs.7.3%). For subgroup analysis by location, there was no statistically significant difference in risk of nonunion for distal humerus fractures or humeral shaft fractures, by surgical indication for risk of nonunion for primary fracture or nonunion, or by surgical indication for time until union for primary fracture or nonunion. There was no statistically significant difference in total complications in all subgroups, except dual plate had an increased risk of total complications versus single plate for distal fractures ( p = 0.014; RR: 1.40). Conclusion: There may be no clinically meaningful differences in risk of nonunion, risk of total complications, and time until union between dual plate versus single plate fixation for humerus fractures in adult patients.

Distal humerus fractures (DHFs) account for around 2% of all adult fractures. Since nonoperative strategies often lead to loss of motion and disability from prolonged immobilization, open reduction and internal fixation (ORIF) is a commonly employed first-line treatment for reconstructable DHFs and can yield satisfactory outcomes. Surgical recovery, however, is not without complications, with reported rates up to 30%. Prior studies often report ORIF in pooled or comparative settings, leaving a gap in isolated ORIF outcomes. Therefore, this study aims to analyze short-term postoperative complications following DHF ORIF. The American College of Surgeons National Surgery Quality Improvement Program database was queried using the Current Procedural Terminology code 24579. Patients with missing relevant variables were excluded. Postoperative outcomes included surgical site infection, wound dehiscence, return to the operating room (ROR), and any adverse event (AAE), among others. Continuous variables were reported as mean (standard deviation) and binary variables as number (%). Multivariate logistic regression with Bonferroni correction was used to model associated risk factors. Additionally, threshold analysis was applied to operative time for modeling complication risk. A total of 833 patients were identified (mean age = 53.9 ± 19.9; 71.8% female; 70.1% white; 68.3% outpatient; 50.1% American Society of Anesthesiologists class 2). Cohort comorbidities included smoking (18%) and diabetes (8.9%; 5.3% non-insulin dependent; 3.6% insulin-dependent). Overall, complication rates were low, with AAE occurring at 5.2% within 30 days. Surgical site infection, ROR, and wound dehiscence were all below 2%. Age (odds ratio [OR] = 1.03), operative time (OR = 1.01), hospital length of stay (OR = 1.2), and smoking (OR = 2.07) significantly increased AAE risk. A 97.1-minute significant operative time threshold was calculated, with complication rates of 7.8% and 1.4% above and below this cutoff, respectively (OR = 5.62). DHF ORIF demonstrates low short-term complication rates. However, factors such as increased age and smoking elicit reasonable operative concerns. Prolonging operative time was significantly associated with increased risks for AAE, the highest of which was observed beyond a 97-minute threshold for operative time. Targeted counseling is recommended, and future studies are warranted to further granularize outcomes.

Purpose: Distal humerus fractures (DHFs) constitute 2% of all fractures, with open reduction and internal fixation (ORIF) often indicated for treatment. Within ORIF literature exists the triceps-reflecting anconeus pedicle (TRAP) approach: an alternative that offers adequate exposure while preserving key soft-tissue structures hypothesised to improve outcomes. Despite this, TRAP-related findings remain poorly collated and lacking consensus. Thus, this systematic review aims to synthesise TRAP-utilising intercondylar DHF ORIF outcomes to guide and inform surgical decision-making. Methods: A PROSPERO-pre-registered query searched PubMed, Ovid-Embase, Cochrane, and Web of Science on June 26th, 2025, for relevant studies. Demographics, range-of-motion (ROM), and complications were among extracted variables. Frequency-weighted means (FWM) and standard deviations, supplemented by narrative synthesis, constituted data analyses. Results: Twelve moderate quality observational studies were included ( n = 295; 59.6% male; FWM age 38.7 ± 10.8 years; follow-up 26.1 ± 9.5 months). All patients underwent TRAP approach DHF ORIF for AO type C fractures (C1 = 29.4%; C2 = 40.7%; C3 = 29.9%), most often from falls or motor vehicle accidents. Union was reported in all cases, and at a FWM 15.7 ± 4.7 weeks. FWM Flexion-extension arc was 113.8˚ ± 12.3, prosupination arc was 157.9˚ ± 8.1, and Mayo Elbow Performance Score was 85.5 ± 8.3. The pooled complication rate was 26.5%, with ulnar nerve-related issues (8.8%) and infection (8.5%) most frequent. Conclusion: The TRAP approach to DHF ORIF appears to yield favorable union, ROM, and functional outcomes; however, ulnar nerve-related issues and infection warrant relative caution. Future large, randomised trials are needed to better optimise alternative surgical approach selection strategies. Level of evidence: Level III.

Medial ulnar collateral ligament (UCL) injuries substantially impair athletic performance due to pain, instability, and diminished throwing capabilities. While UCL reconstruction is the primary surgical treatment due to its reliable restoration of stability and high return-to-play rates, direct UCL repair has re-emerged as an alternative in select cases. For the purposes of this study, both procedures are collectively referred to as UCLR (UCL reconstruction/repair). The long rehabilitation period and complications such as ulnar neuropathy and stiffness remain concerns. Existing literature emphasizes long-term outcomes, leaving a large gap concerning short-term complication rates. To address this gap, the present study evaluates the predictive variables associated with adult UCLR 30-day postoperative complications, potentially refining surgical planning and improving patient outcomes. The American College of Surgeons National Surgical Quality Improvement Program was queried for Current Procedural Terminology (CPT) codes 24345 and 24346, excluding codes related to ulnar nerve neurolysis or transposition (CPT 64718). The primary outcome was any adverse event (AAE) within 30 days. Secondary outcomes were specific medical and surgical complications. Descriptive analysis for both 24345 and 24346 alone were included. Multivariable logistic regression examined the independent effect of age, BMI, operative time, and LOS on AAE. An operative-time threshold analysis was also performed to look for inflection points that increased risk. A total of 464 adult UCLR patients met the inclusion criteria with a median age of 33 years [21-56] and median BMI of 26.6 kg/m2 [24.2-31.6]. Thirty-day complications were low, with an AAE rate of 2.4%, surgical site infection rate of 1.1%, return to the operating room at 0.9%, and a mortality of 0.2%. Extended LOS occurred in 8.4% but was not counted as a complication. No studied demographic-, comorbidity-, or surgical-related metrics were associated with higher risks of experiencing AAE. An operative-time cut-off of 78.7 minutes did not reach statistical significance (p=0.196). In a 2010-2023 NSQIP cohort of 464 UCLRs, 30-day morbidity remained very low (AAE 2.4%, SSI 1.1%, and mortality 0.2%), and multivariable analysis showed no independent predictors. These data reinforce prior registry work showing similarly low event rates, confirming UCLR as safe outpatient procedures. Future longitudinal studies are necessary to clarify whether this short-term low-risk profile translates into long-term durable and functional success. Level III.