Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones

Gruszka, Dominik; Arand, Charlotte; Greenfield, Julia; Nowak, T.; Kuechle, R.; Kühn, Sebastian; Rommens, Pol Maria

doi:10.1007/s00402-017-2760-5

Cited by 19 publications

(16 citation statements)

References 31 publications

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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%

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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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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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“…procedures have been developed, such as shaped plates, intramedullary rods, precontoured plates, and tendon sutures. [10,11] As a result, PF with locking screws has been preferred most frequently as an alternative to TBW by surgeons. Plate fixation can be used safely for all olecranon fractures, particularly oblique and complex fractures.…”

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confidence: 99%

Comparison of tension band wiring and plate fixation in Mayo type 2A olecranon fractures

et al. 2021

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Objectives This study aims to compare clinically and functionally patients who had previously undergone tension band wiring (TBW) or plate fixation (PF) procedure due to the diagnosis of Mayo type 2A olecranon fracture in our clinic. Patients and methods Data of 92 patients (51 males, 41 females; mean age 42.3±12.6 years; range, 16 to 75 years) operated on for olecranon fractures between January 2014 and December 2018 were recorded retrospectively. Forty-four patients received TBW and 48 patients received PF treatment. Their Disabilities of the Arm, Shoulder, and Hand (DASH) and Mayo scores and elbow range of motion (ROM) measurements were used for clinical and functional evaluations. Data including the time to return to work, revision rate, and follow-up time were also recorded. Results The mean follow-up time was 38.2±17.2 months. Patients returned to work in 9.2±4.1 weeks in the TBW group and 7.8±3.6 weeks in the PF group (p=0.279). The revision rate was 14% in the TBW group and 2% in the PF group (p=0.335). The mean DASH score was 10.0±1.8 in the TBW group and 7.7±1.2 in the PF group (p=0.001). The mean Mayo score was 84.0±9.3 in the TBW group and 88.3±9.1 in the PF group (p=0.049). For elbow flexion-extension ROM, 4° of difference was measured in favor of the PF group (p=0.043). Mean Mayo score, mean DASH score, and mean flexion-extension ROM values were statistically significantly different between the two groups. Conclusion Both surgical techniques are suitable and reliable in the treatment of olecranon fractures. Although TBW treatment is low-cost and simple to apply, its biggest disadvantage is a high rate of secondary surgery for implant removal due to irritation of the skin.

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“…Numerous alternative fixation methods have been developed in an effort to reduce the rate of secondary surgery, including all-suture techniques, 1 intramedullary rods, 16 tension plates, 7 and olecranon sleds. 11 Nevertheless, TBW and PF remain the preferred methods for operative treatment of isolated, displaced olecranon fractures.…”

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confidence: 99%

Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients

Midtgaard¹,

Frihagen²,

Dornan³

et al. 2021

JSES International

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Background High rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures. Methods Olecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built. Results After the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% ( P = .96). The adjusted risk of secondary surgery was lower with increasing age (odds ratio by 10 years increments, 0.74; 95% confidence interval, 0.68-0.80, P < .01). Compared with PF, TBW with transcortical K-wires (odds ratio, 2.06; 95% confidence interval, 1.36-3.14; P < .01) and TBW with intramedullary K-wires (odds ratio, 4.32; 95% confidence interval, 2.16-8.86, P < .01) had significantly higher adjusted risk of secondary surgery. Conclusion Surgeons preferred to use PF in younger patients and multifragmented fractures. Patients should be counseled that secondary surgery is common after surgical fixation of olecranon fractures. Symptomatic hardware removal was the most frequently reported reason for secondary surgery and more frequent after TBW. When using TBW, intramedullary K-wire positioning should be avoided. The rate of major complications leading to secondary surgery was similar in the TBW and PF groups. Overall, the risk of subsequent secondary surgery was higher in younger patients and patients treated with TBW.

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Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones

Abstract: The low-profile OTP, using the principles of pre-tensioning, lag, cortical, and angular stable screws together, demonstrated similar stability after olecranon fracture fixation when compared with the TBW technique and a lag screw in the olecranon fracture model with a third wedge fragment.

Cited by 19 publications

References 31 publications

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

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

Comparison of tension band wiring and plate fixation in Mayo type 2A olecranon fractures

Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients

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