Biomechanical Evaluation of Standard Versus Extended Proximal Fixation Olecranon Plates for Fixation of Olecranon Fractures

Boden, Allison L.; Daly, Charles A.; Dalwadi, Poonam; Boden, Stephanie; Hutton, William; Muppavarapu, Raghuveer C.; Gottschalk, Michael B.

doi:10.1177/1558944717753206

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…To study the biomechanics of elbow trauma, it is often a challenge to establish a model which is practically and ethically acceptable and also provides reliable results. Many studies have tested the biomechanical function of fixation by using fresh-frozen human cadaveric elbows 8 , 31 , 32 . However, ethical considerations to allow such cadaveric research are very difficult in our institute.Synbone models are often used in biomechanical experiments 33 , 34 .…”

Section: Discussionmentioning

confidence: 99%

The effect of Ding’s screws and tension band wiring for treatment of olecranon fractures: a biomechanical study

Zhao,

Tian,

Yin

et al. 2024

Sci Rep

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Although tension band wiring (TBW) is popular and recommended by the AO group, the high rate of complications such as skin irritation and migration of the K-wires cannot be ignored. Ding’s screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by biomechanical testing. We conducted a Synbone biomechanical model by using three fixation methods: DSTBW, intramedullary screw and tension band wiring (IM-TBW), and K-wire TBW, were simulated to fix the olecranon fractures. We compared the mechanical stability of DSTBW, IM-TBW, and TBW in the Mayo Type IIA olecranon fracture Synbone model using a single cycle loading to failure protocol or pullout force. During biomechanical testing, the average fracture gap measurements were recorded at varying flexion angles in three different groups: TBW, IM-TBW, and DSTBW. The TBW group exhibited measurements of 0.982 mm, 0.380 mm, 0.613 mm, and 1.285 mm at flexion angles of 0°, 30°, 60°, and 90° respectively. The IM-TBW group displayed average fracture gap measurements of 0.953 mm, 0.366 mm, 0.588 mm, and 1.240 mm at each of the corresponding flexion angles. The DSTBW group showed average fracture gap measurements of 0.933 mm, 0.358 mm, 0.543 mm, and 1.106 mm at the same flexion angles. No specimen failed in each group during the cyclic loading phase. Compared with the IM-TBW and TBW groups, the DSTBW group showed significant differences in 60° and 90° flexion angles. The mean maximum failure load was 1229.1 ± 110.0 N in the DSTBW group, 990.3 ± 40.7 N in the IM-TBW group, and 833.1 ± 68.7 N in the TBW group. There was significant difference between each groups (p < 0.001).The average maximum pullout strength for TBW was measured at 57.6 ± 5.1 N, 480.3 ± 39.5 N for IM-TBW, and 1324.0 ± 43.8 N for DSTBW. The difference between maximum pullout strength of both methods was significant to p < 0.0001. DSTBW fixation provides more stability than IM-TBW and TBW fixation models for olecranon fractures.

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Section: Discussionmentioning

confidence: 99%

The effect of Ding’s screws and tension band wiring for treatment of olecranon fractures: a biomechanical study

Zhao,

Tian,

Yin

et al. 2024

Sci Rep

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“…Those studies suggested that risk of failure is higher with osteoporotic bone and when the fracture is proximal to the midpoint of sigmoid notch. The use of 2 proximal triceps screws and augmentation with SR or TBW might be beneficial in more proximal fractures [51][52][53][54][55][56][57][58][59][60][61][62] (Fig. 6).…”

Section: Plate Osteosynthesismentioning

confidence: 99%

Olecranon Fractures

2023

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Olecranon fractures account for 10% of all elbow fractures and are more likely to result from a low-energy injury. A displaced fracture with a stable ulnohumeral joint (Mayo type 2) is the most common type of injury.» The management of an isolated olecranon fracture is based on patient factors (age, functional demand, and if medically fit to undergo surgery) and fracture characteristics including displacement, fragmentation, and elbow stability.» Nonoperative management can be successfully used in undisplaced fractures (Mayo type 1) and in displaced fractures (Mayo type 2) in frail patients with lower functional demands.» Patients with displaced olecranon fractures with a stable ulnohumeral joint without significant articular surface fragmentation (Mayo type 2A) can be managed with tension band wiring, plate osteosynthesis (PO), intramedullary fixation, or suture repair.» PO is advocated for multifragmentary fractures and fractures that are associated with ulnohumeral instability. It is essential to consider the variable anatomy of the proximal ulna during surgery.

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“…The 13 included studies represent 274 cadaveric specimens and 55 cohorts of olecranon fractures fixated with either tension band wiring, intramedullary screw, or plating technique (Table 1). 7,8,[14][15][16][17][18][19][20][21][22][23][24][25] Cohorts that tested fracture patterns with no cortical contact were eliminated. These studies evaluated maximum mean displacement at the fracture site during cyclic loading of the extensor mechanism.…”

Section: Included Studiesmentioning

confidence: 99%

“…13 loading that simulates high-intensity physiologic demands. 7,8,[14][15][16][17][18][19][20][21][22][23][24][25] To better understand the biomechanical properties of olecranon fixation constructs, we performed a systematic review and meta-regression of published data related to this topic.…”

Section: Introductionmentioning

confidence: 99%

The biomechanical strength of olecranon fixation constructs: a systematic review and meta-regression

et al. 2022

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<p class="abstract">Olecranon fractures are often operative when displaced over 2 mm, but the most stable fixation construct is debated. The purpose of this study was to provide an overview of biomechanical properties of the most commonly used surgical fixations of olecranon fractures. This systematic review included 13 biomechanical studies comparing displacement during cyclic loading of olecranon fractures fixated with either tension band wiring (TBW), intramedullary screw, or plate fixation. In regard to overall gapping, plates displayed (and screws trended towards) increased stability versus TBW. However, there was no difference between the constructs in gapping at the articular surface. Plating displayed increased stability along the posterior surface. No construct allowed gapping over 2 mm, suggesting safe early post-operative motion with any of the techniques.</p>

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Biomechanical Evaluation of Standard Versus Extended Proximal Fixation Olecranon Plates for Fixation of Olecranon Fractures

Abstract: Standard fixation plates are sufficient for the fixation of small transverse fractures, but caution should be utilized particularly with comminution and nontransverse fracture patterns.

Cited by 9 publications

References 28 publications

The effect of Ding’s screws and tension band wiring for treatment of olecranon fractures: a biomechanical study

The effect of Ding’s screws and tension band wiring for treatment of olecranon fractures: a biomechanical study

Olecranon Fractures

The biomechanical strength of olecranon fixation constructs: a systematic review and meta-regression

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