Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques

Background: Fractures of olecranon are common fractures in upper limb. Tension band wiring (TBW) and plate fixation (PF) are mostly used techniques but choice is based on type of fracture and surgeon’s preference.Methods: A study assessed functional results in 28 patients that were enrolled after the clinical event of trauma has occurred. Patients were divided into two groups- Group (A) for TBW and Group (B) for PF; here gender, age and side of fracture were ignored. Post-operative functional outcome were evaluated by using the Mayo Elbow Performance (MEP) and the Disabilities of the Arm, Shoulder and Hand (DASH) score parameters.Results: Mean (SD) union time as determined by postoperative radiographs was 8.5 (1.48) weeks for group (A) and 9 (2.08) weeks for group (B). Mean (SD) MEP score at 9 months in group (A) 84.28 (7.28) and 80.71 (10.92) in group (B). Mean (SD) DASH at 9 months in group (A) 12.2 (8.8) and 11.7 (10.4) in group (B). Complications were reported in group (A) 6 patient (42.85%) out of 14 patients and in group (B) 1 patient (7.14%) out of 14 patients.Conclusions: The current study shows that there are no significant differences in functional outcome between both the study groups. Due to lesser complications, we recommend the plate fixation approach as the better choice for transverse displaced olecranon fractures. More large scale studies are required to further confirm our results.

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Intramedullary screw fixation for simple displaced olecranon fractures

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-019-01114-4 ◽

2019 ◽

Vol 46 (1) ◽

pp. 83-89 ◽

Cited By ~ 1

Author(s):

Willem-Maarten P. F. Bosman ◽

Benjamin L. Emmink ◽

Abhiram R. Bhashyam ◽

R. Marijn Houwert ◽

Jort Keizer

Keyword(s):

Soft Tissue ◽

Plate Fixation ◽

Cannulated Screw ◽

Tension Band ◽

Tension Band Wiring ◽

Hardware Removal ◽

Dash Score ◽

Intramedullary Screw ◽

Olecranon Fractures

Abstract Purpose Olecranon fractures are common and typically require surgical fixation due to displacement generated by the pull of the triceps muscle. The most common techniques for repairing olecranon fractures are tension-band wiring or plate fixation, but these methods are associated with high rates of implant-related soft-tissue irritation. Another treatment option is fixation with an intramedullary screw, but less is known about surgical results using this strategy. Thus, the purpose of this study was to report the clinical and functional outcomes of olecranon fractures treated with an intramedullary cannulated screw. Methods We identified 15 patients (average age at index procedure 44 years, range 16–83) with a Mayo type I or IIA olecranon fracture who were treated with an intramedullary cannulated screw at a single level 2 trauma center between 2012 and 2017. The medical record was reviewed to assess radiographic union, postoperative range of motion and complications (including hardware removal). Patient-reported outcome was evaluated using the Disabilities of the Arm, Shoulder and Hand (DASH) score. Average follow-up was 22 months (range 8–36 months). Results By the 6th month post-operative visit, 14 patients had complete union of their fracture and 1 patient had an asymptomatic non-union that did not require further intervention. Average flexion was 145° (range 135–160) and the average extension lag was 11° (range 0–30). Implants were removed in 5 patients due to soft-tissue irritation. Average DASH score (± standard deviation) by final follow-up was 16 ± 10. Conclusions Fixation of simple olecranon fractures with an intramedullary screw is a safe and easy fixation method in young patients, leading to good functional and radiological results. Compared to available data, less hardware removal is necessary than with tension-band wiring or plate fixation.

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Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-016-0465-z ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 19

Author(s):

Yi-Ming Ren ◽

Hu-Yun Qiao ◽

Zhi-Jian Wei ◽

Wei Lin ◽

Bao-You Fan ◽

...

Keyword(s):

Systematic Review ◽

Plate Fixation ◽

Meta Analysis ◽

Tension Band ◽

Tension Band Wiring ◽

Efficacy And Safety ◽

Olecranon Fractures

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Comparison of the efficacy of the tension band wiring with eyelet wire versus anatomical locking plate fixation for the treatment of displaced olecranon fractures

Journal of Orthopaedic Surgery ◽

10.1177/23094990211059231 ◽

2021 ◽

Vol 29 (3) ◽

pp. 230949902110592

Author(s):

Haruhiko Shimura ◽

Akimoto Nimura ◽

Koji Fujita ◽

Hidetoshi Kaburagi

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Locking Plate ◽

Plate Fixation ◽

Elbow Flexion ◽

Tension Band ◽

Tension Band Wiring ◽

Locking Plate Fixation ◽

The Mean ◽

Olecranon Fractures

Background This retrospective study was conducted to assess the clinical outcome and complications between tension band wiring (TBW) with eyelet wire and locking plate fixation used for the treatment of displaced olecranon fractures. Methods A total of 58 patients (36 males and 22 females; mean age: 63 years) were reviewed between April 2014 and September 2020. TBW with Ring Pin (RP group) was applied in 24 patients, including 15 Mayo type ⅡA and 9 Mayo type ⅡB patients. Anatomical locking plate (ALP group) was used in 34 patients, including 22 Mayo type ⅡA and 12 Mayo type ⅡB patients. Clinical outcome was evaluated using the Mayo Elbow Performance Score (MEPS), and active range of motion of the elbow and forearm and postoperative complications were reviewed. Results General characteristic of the patients and the fracture type were similar in the two groups. The mean MEPS values were 96.5 ± 7.3 in the RP group and 94.9 ± 9.4 in the ALP group. The mean elbow flexion arc was 127°±11 in the RP group. The mean elbow flexion arc was 122°±18 in the ALP group. No significant differences in clinical outcomes were observed between the two groups. Complication rates were significantly higher in the ALP group (19/34: 56%) than in the RP group (6/24: 25%). Conclusion Although there were no statistically significant differences in clinical outcomes between the two groups, the ALP group had a higher proportion of any complication than the RP group.

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Biomechanical comparison of tension band wiring and plate fixation with locking screws in transverse olecranon fractures

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.01.079 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1242-1248

Author(s):

Kaare Sourin Midtgaard ◽

Endre Søreide ◽

Jan Egil Brattgjerd ◽

Gilbert Moatshe ◽

Jan Erik Madsen ◽

...

Keyword(s):

Plate Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Locking Screws ◽

Biomechanical Comparison ◽

Olecranon Fractures

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Comparative study of tension band wiring and pre contoured locking compression plate fixation in olecranon fractures in adults

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211932 ◽

2021 ◽

Author(s):

Mohit Mahoviya ◽

Pradeep Choudhari ◽

Divyanshu Patel ◽

Arpit Choyal

Keyword(s):

Comparative Study ◽

Internal Fixation ◽

Plate Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Improvement Rate ◽

Articular Fractures ◽

Group A ◽

Group B ◽

Olecranon Fractures

Background: Olecranon fractures are about 10% of all proximal forearm fractures.Mostly intra articular fractures, require anatomical reduction and internal fixation for satisfactory clinical outcomes. The most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of olecranon fractures.Methods: This is a comparative study including 30 adult patients of olecranon fracture classified by Mayo classification and operated upon by tension band plating (group A) and tension band wiring (group B) at Department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All operated cases between the period of January 2018 to August 2019 with follow up of 1 year were assessed on the basis of functional outcome using Mayo elbow performance score (MEPS).Results: The MEPS, 73% of the patients in group A achieved a good to excellent results in comparison to 60% in group B. no significant differences between the two groups could be detected regarding the clinical and radiographic outcome.Conclusions: Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in MEPS, improvement rate and ROM between TBW and PF for OFs. More high-quality studies are required to further confirm our results as most of the cases included in study belonged to Mayo type IIA category.

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More metalwork removals in patients with olecranon fracture treated by tension band wiring than plate fixation-a propensity score matching analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04559-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Longhai Qiu ◽

Yi Li ◽

Hongbo Wu ◽

Ruixiong Chen ◽

Zhiwen Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Propensity Score ◽

Propensity Score Matching ◽

Plate Fixation ◽

Treatment Method ◽

Tension Band ◽

Tension Band Wiring ◽

Olecranon Fracture ◽

Propensity Score Matching Analysis ◽

Olecranon Fractures

Abstract Background Traditional tension band wiring and plate fixation represent the commonest methods for treating olecranon fractures. However, there is no agreement on which method provides the best outcome. The aim of this retrospective study is to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture. Method A total of 107 patients aged between 18 and 85 had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n = 49) or PF (n = 58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation. Results Functional effects between two groups are similar (in terms of Mayo Elbow Performance Score (MEPS), the patients’ range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, similar primary treatment efficacy (indicated by MEPS> 90) in 2 groups and more primary adverse events (indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient = − 1.24 < 0, P = 0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group. Conclusion When initially discussing the surgical approach with patients, physicians should fully weigh the possibility that TBW may lead to a second surgery due to the higher risk of internal fixation removal and that TBW won’t yield better functional outcomes than PF .

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