Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study

Abstract

BackgroundTension band wiring (TBW) remains the most common operative technique for the internal fixation of olecranon fractures despite the potential occurrence of subjective complaints due to subcutaneous position of the hardware. Aim of this long term retrospective study was to evaluate the elbow function and the patient-rated outcome after TBW fixation of olecranon fractures.MethodsWe reviewed 62 patients (33 men and 29 women) with an average age of 48.6 years (range, 18–85 years) who underwent TBW osteosynthesis for isolated olecranon fractures. All patients were assessed both clinically with measurement of flexion-extension and pronation-supination arcs and radiologically with elbow X-Rays. Functional outcome was estimated using the Mayo Elbow Performance Score (MEPS), Visual Analogue Scale (VAS) subjective pain score and VAS patient satisfaction score. Follow up: 6–13 years (average 8.2 years).ResultsThere was a higher prevalence of fractures among men until the 5th decade of life and among women in elderly (p = 0.032). Slip or simple fall onto the arm was the main mechanism of injury for 38 fractures (61.3%) while high energy trauma, such as fall from a height (> 2 m) or road accident, was reported in 24 fractures (38.7%). Hardware removal performed in 51 patients (82.3%) but 34 of them (66.6% of removals) were still complaining for mild pain during daily activities. The incidence of pin migration and loosening was not statistically decreased when penetration of the anterior ulnar cortex was accomplished (p = 0.304). Supination was more often affected than pronation (p = 0.027). According to MEPS, 53 patients (85.5%) had a good to excellent result, 6 (9.7%) fair and 3 (4.8%) poor result. The average satisfaction rating was 9.3 out of 10 (range, 6–10) with 31 patients (50%) to remain completely satisfied from the final result. Degenerative changes recorded in 30 elbows (48.4%). However, no correlation could be found between radiographic findings and MEPS (p = 0.073).ConclusionTension band wiring fixation remains the "gold standard" for the treatment of displaced and minimally comminuted olecranon fractures. In long term, low levels of pain may be evident regardless of whether the metalware is removed and degenerative changes have been developed.

Treatment of Transverse Olecranon Fractures: Comparison Between Tension Band Wiring And Transcortical Screw

“…Our findings are consistent with those stated by Chalidiset al 13 and Lindenhoviuset al 14 and somewhat superior to that of Van der Linden et al 15 in terms of range of motion. Moreover flexion contracture or extension loss was found to somewhat similar as compared to most of the other studies.…”

“…Chalidis et al 13 In our study we achieved similar results with respect to mean flexion, mean arc of motion and mean supination pronation arc compared to earlier studies. Our findings are consistent with those stated by Chalidiset al 13 and Lindenhoviuset al 14 and somewhat superior to that of Van der Linden et al 15 in terms of range of motion.…”

Clinical Evaluation of Locking Compression Plate Fixation for Comminuted Olecranon Fractures

“…Moreover, a proximal ''home run'' screw is positioned through the coronoid process, instead of the longer intramedullary screw that is used in our technique. In the study by Anderson et al, 92% of the patients had a good or excellent result, but among the patients with a comminuted olecranon fracture the mean DASH score (26) and mean MEPI score (88) were slightly less favorable than the scores in our patients. Anderson et al reported one case of construct failure and a much lower rate of plate removal (9.3%) as compared with that in our series (56%).…”

“…A possible explanation is that the locking compression plate does not contour closely to the bone, although it has been our experience that patients are inconvenienced by the implant regardless of how well it is contoured to the bone. Long-term follow-up studies on tension band fixation for the treatment of olecranon fractures have shown rates of hardware removal of >80% [26][27][28] . Furthermore, at some institutions, hardware removal has even been considered as routine practice 28 .…”

Comparative study of management of olecranon fractures using tension band wiring technique with cancellous screw and K wires

“…17 In Byron E Chalidis et al, reviewed 62 patients of isolated olecranon fractures and came to a conclusion that tension band wiring technique is the "Gold standard" for the treatment of olecranon fractures and leads to good elbow function and minimal loss of physicalcapacity. 18 Tension band wiring with K-wire is the most common method for fixation of olecranon fractures and it works on the principle of converting tensile forces to compressive forces at fracture site, it usually gives good result but cancellous screws with tension band wiring combination provides the strength of fixation that is by converting the tensile force to a compressive force at the fracture site with additional resistance to the displacement due to the lag screw compression.…”