Wireless Tension Band Wiring for Olecranon Fractures : Case Series

Roukoz, Sami; Bayoud, Wael

doi:10.12816/0031525

Cited by 3 publications

(12 citation statements)

References 8 publications

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“…That investigation was performed at the same department, and we believe our results to better reflect the current situation with a higher threshold to hardware removal. A small case series of cerclage fixation without K-wires reported hardware removal in 4 of 17 patients, and good clinical outcomes at almost 5-year follow-up [ 23 ]. Another paper describing a similar technique with non-absorbable sutures also reported a low reoperation rate, although only 17 fractures and 11 osteotomies were included and the follow-up time was not specified [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients

Wenger

Cornefjord

Rogmark

2021

Arch Orthop Trauma Surg

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Introduction Tension band wiring of olecranon fractures has high reported rates of complications and reoperations. We aimed to compare classic tension band wiring to cerclage fixation without K-wires in the treatment of displaced olecranon fractures in elderly patients. The primary outcome was reoperation. Secondary outcomes included complications and patient reported outcomes. Outcomes following non-operative treatment were also studied. Materials and methods Patients aged > 69 years presenting with Mayo class 2a and 2b olecranon fractures at our institution from 2004 through 2016 (n = 239) were eligible for study. Fracture type, treatment method, complications and reoperations were assessed from radiographs and hospital files. QuickDASH surveys were collected by mail. Results Patients operated with tension band wire technique had more reoperations (p value 0.03): relative risk (RR) 2.2 (CI 1.08–4.3), odds ratio (OR) 2.6 (CI 1.05–6.4), and complications (p value 0.001): RR 2.5 (CI 1.51–4.1), OR 3.7 (CI 1.67–8.2), compared with those operated with cerclage technique. Non-operative treatment yielded similar complication (p value 0.2) and reoperation rates (p value 0.06) as cerclage fixation. The answer rate was insufficient to compare QuickDASH scores between treatments methods. Conclusions In patients 70 years and older undergoing cerclage fixation for displaced stable olecranon fractures (Mayo class 2), the reoperation and complications rates were less than half of those in patients undergoing TBW fixation. Non-operative treatment yielded similar reoperation and complication rates to cerclage fixation, in selected cases. Level of evidence III—retrospective comparative cohort study.

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Section: Discussionmentioning

confidence: 99%

Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients

Wenger

Cornefjord

Rogmark

2021

Arch Orthop Trauma Surg

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“…Eventually, five studies were included in the qualitative synthesis of this review [15][16][17][18][19]. A further four studies were used in the discussion but not included in the results, due to the lack of statistical analysis [20][21][22][23] (Figure 1). Table 1 highlights the baseline characteristics of the five included studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Four studies identified in the article screening did not have statistical analysis, however fulfilled the remainder of the eligibility criteria [20][21][22][23]. Whilst these studies cannot be used in the results of this review, they remain useful for discussion.…”

Section: Studies Without Statistical Analysismentioning

confidence: 99%

“…In terms of functional outcomes, the TBW study reported a mean DASH score of 12 [20], and two of the TBS studies reported mean MEPS of 96.6 and 85 [21,23]. All four studies measured range of motion.…”

Section: Studies Without Statistical Analysismentioning

confidence: 99%

“…In TBS, mean elbow flexion ranged from 129 to 143.8 degrees and mean extension ranged from -3 to -4.8 degrees, with the flexion-extension arc ranging from 127 to 139 degrees [21][22][23]. In the TBW study, there was a 3 degree loss in elbow flexion and forearm pronation, and a 4 degree loss in elbow extension and forearm supination [20] (Table 7).…”

Section: Studies Without Statistical Analysismentioning

confidence: 99%

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Metal Tension-Band Wires vs Tension-Band Sutures in the Fixation of Olecranon Fractures: A Systematic Review

Shaunak¹,

Dadrewalla²,

Sinha³

et al. 2022

austinjorthopaderheumatol

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Background: Tension-Band Wiring (TBW) is the treatment of choice for displaced, non-comminuted olecranon fractures. Due to the high complication rate involved with TBW, particularly the need for re-operative hardware removal, an alternate method using a high-strength, non-metallic Tension-Band Suture (TBS) construct has been precipitated. There is currently no literature comparing and evaluating these 2 particular techniques, therefore, this systematic review aims to address this. Methods: 6 databases were searched (MEDLINE, Embase, Web of Science, Cochrane Library, The CRD and Clinicaltrials.gov). Titles, abstracts and full articles were then systematically screened against the eligibility criteria. The primary outcomes studied were reported postoperative functional outcomes, and complication rates. Results: From 2538 identified abstracts, 5 studies met our eligibility criteria. Only one study compared TBW with TBS and concluded that in paediatric patients, there is a lack of benefit from TBS due to a similar rate of reoperation for hardware removal. 4 studies solely analysed TBW. In TBW, the rate of reoperation reached as high as 76.5% with the need for hardware removal being the most common indication. Conclusion: This review was required to highlight the alarming paucity of studies analysing TBS fixation in the treatment of non-comminuted olecranon fractures. Based on the included studies, it is difficult to conclude an advantage for either TBW or TBS due to the lack of standardised measuring of functional outcomes and comparative studies. There is potential for a reduced rate of reoperation in TBS, however, there is a great need for more robust studies analysing this technique.

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The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial

Cornefjord,

Kostogiannis,

Rogmark

et al. 2023

Trials

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Background Displaced olecranon fractures with a stable elbow joint are classified as Mayo type 2a or 2b and are commonly operated with tension band wiring, i.e. two K-wires and a cerclage. Retrospective studies have reported fewer reoperations and complications with cerclage fixation alone when compared to tension band wiring, though with similar long-term results. We decided to compare tension band wiring to cerclage fixation of displaced, stable olecranon fractures in adults in a randomized controlled trial. Methods All patients ≥ 18 years old with Mayo type 2a and 2b fractures presenting at Skåne University hospital will be eligible for study inclusion, unless exclusion criteria are met. Two hundred participants will be included and randomized 1:1 to cerclage fixation or tension band wiring. Outpatient physiotherapist follow-up appointments will be scheduled at 2 and 6 weeks and at 3, 12, and 36 months at the Dept. of Orthopaedics. A lateral view radiograph of the elbow will be analysed at 6 months. The primary outcome of our study is the rate of reoperations. Secondary outcomes are complication rates, severity of complications, and patient-reported outcome measures (QuickDASH, Short Musculoskeletal Function Assessment, pain level, and patient satisfaction). The sample size was calculated to give 80% power for detecting a statistically significant difference in reoperation rates (with alpha-value 0.05), based on a previous retrospective study. Discussion Reoperation and complication rates after tension band wiring of olecranon fractures are high. Treatment of these injuries is debated, and several ongoing trials compare tension band wiring with plate fixation, suture fixation, and non-operative treatment. As data from retrospective studies indicate that cerclage fixation may be superior to tension band wiring, we see a need for a randomized controlled trial comparing these methods. The WOW-OK Trial aims to obtain level-1 evidence that may influence treatment choice for this type of fracture. Trial registration ClinicalTrials.gov NCT05657899. Registered on 16 November 2022. The trial complies with SPIRIT and CONSORT guidelines. The SPIRIT figure is found in Table 2.

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Wireless Tension Band Wiring for Olecranon Fractures : Case Series

Cited by 3 publications

References 8 publications

Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients

Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients

Metal Tension-Band Wires vs Tension-Band Sutures in the Fixation of Olecranon Fractures: A Systematic Review

The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial

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