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Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection

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Abstract

Purpose

The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique.

Methods

This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning.

Results

On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91 % of all cases), the use of a single wire knot (78 %) and nonparallel K-wires (72 %). Mayo IIa (n = 188) was the most common fracture type.

Conclusions

Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated.

Level of Evidence: IV, treatment study

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Albertus Magnus University, Cologne, Germany

    Marco M. Schneider, Lars P. Müller & Klaus J. Burkhart

  2. Department of Orthopaedic Surgery, Traumatology and Sports Medicine, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany

    Marco M. Schneider

  3. Department of Orthopaedics and Traumatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany

    Tobias E. Nowak & Pol M. Rommens

  4. Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Klinikum Leverkusen GmbH, Leverkusen, Germany

    Leonard Bastian

  5. Department of Trauma and Reconstructive Surgery, Friederikenstift Hospital Hannover, Hannover, Germany

    Jan C. Katthagen

  6. Department of Trauma and Orthopaedic Surgery, KRH Klinikum Nordstadt, Hannover, Germany

    Jörg Isenberg

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  1. Marco M. Schneider
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Corresponding author

Correspondence to Marco M. Schneider.

Additional information

Marco M. Schneider and Tobias E. Nowak contributed equally as co-first authors.

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Schneider, M.M., Nowak, T.E., Bastian, L. et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. International Orthopaedics (SICOT) 38, 847–855 (2014). https://doi.org/10.1007/s00264-013-2208-7

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  • DOI: https://doi.org/10.1007/s00264-013-2208-7

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