Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 8, pp 1107–1114 | Cite as

Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques

  • Luigi Tarallo
  • Raffaele Mugnai
  • Roberto Adani
  • Francesco Capra
  • Francesco Zambianchi
  • Fabio Catani
Trauma Surgery

Abstract

Introduction

The purpose of this retrospective study is to compare the clinical, functional outcome and complications occurrence between tension band wiring (TBW) and plate fixation both for simple and comminuted displaced olecranon factures.

Materials and methods

Between January 2005 and June 2012 (minimum 1-year follow-up), 78 consecutive patients with Mayo type IIA and IIB fractures were treated with the following methods: tension band wire or plate and screws fixation. The primary outcome of this study was the functional outcome, assessed by the following self-administered evaluation scales: the disabilities of the arm, shoulder and hand, and the Mayo Elbow Performance Score. Secondary outcome measures included the assessment of pain level, analysis of passive range of motion, and the occurrence of any early or late complications.

Results

Comparing the clinical results between the two groups, at mean 33 months follow-up, no significant differences in the functional and clinical outcome were observed. Complications were reported in 48 and 17 % of cases, following TBW and plate fixation in patients treated for type IIA fractures, and similarly in 40 and 23 % of cases in type IIB fractures, respectively. Hardware removal was more frequently performed in TBW group: 38 versus 17 % for type IIA fractures and 20 versus 6 % for type IIB fractures.

Conclusions

The findings of this study indicate that both with the use of TBW and plate fixation excellent/good clinical outcomes with minimal loss of physical capacity, little pain and disability can be obtained in the majority of patients with simple and comminuted displaced olecranon fractures. Hardware removal was most frequently observed after TBW.

Level of evidence

Therapeutic IV.

Keywords

Tension band wiring Plate fixation Olecranon fracture Mayo DASH Complications Outcome 

Notes

Conflict of interest

All the authors declare that they have no conflict of interest.

References

  1. 1.
    Rommens PM, Kuchle R, Schneider RU, Reuter MM (2004) Olecranon fractures in adults: factors influencing outcome. Injury 35(1):1149–1157CrossRefPubMedGoogle Scholar
  2. 2.
    Veillette CJ, Steinmann SP (2008) Olecranon fractures. Orthop Clin North Am 39:229–236. doi: 10.1016/j.ocl.2008.01.002 CrossRefPubMedGoogle Scholar
  3. 3.
    Bennett JB, Mehlhoff TM (2002) Treatment of olecranon, coronoid, and proximal ulnar fracture-dislocation. In: Baker CL, Plancher KD (eds) Operative treatment of elbow injuries. Springer, New York, pp 259–270CrossRefGoogle Scholar
  4. 4.
    Newman SD, Mauffrey C, Krikler S (2009) Olecranon fractures. Injury 40:575–581. doi: 10.1016/j.injury.2008.12.013 CrossRefPubMedGoogle Scholar
  5. 5.
    Sadri H, Stern R, Singh M, Linke B, Hoffmeyer P, Schwieger K (2011) Transverse fractures of the olecranon: a biomechanical comparison of three fixation techniques. Arch Orthop Trauma Surg 131:131–138. doi: 10.1007/s00402-010-1156-6 CrossRefPubMedGoogle Scholar
  6. 6.
    Molloy S, Jasper LE, Elliott DS, Brumback RJ, Belkoff SM (2004) Biomechanical evaluation of intramedullary nail versus tension band fixation for transverse olecranon fractures. J Orthop Trauma 18:170–174CrossRefPubMedGoogle Scholar
  7. 7.
    Wolfgang G, Burke F, Bush D, Parenti J, Perry J, LaFollette B, Lillmars S (1987) Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop Relat Res 224:192–204PubMedGoogle Scholar
  8. 8.
    Holdsworth BJ, Mossad MM (1984) Elbow function following tension band fixation of displaced fractures of the olecranon. Injury 16:182–187CrossRefPubMedGoogle Scholar
  9. 9.
    Macko D, Szabo RM (1985) Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 67:1396–1401PubMedGoogle Scholar
  10. 10.
    Helm RH, Hornby R, Miller SW (1987) The complications of surgical treatment of displaced fractures of the olecranon. Injury 18:48–50CrossRefPubMedGoogle Scholar
  11. 11.
    Koslowsky TC, Mader K, Dargel J, Schadt R, Koebke J, Pennig D (2009) Olecranon fracture fixation with a new implant: biomechanical and clinical considerations. Injury 40:618–624. doi: 10.1016/j.injury.2009.01.129 CrossRefPubMedGoogle Scholar
  12. 12.
    Rompen JC, Vos GA, Verheyen CC (2010) Acute ischemia of the hand seven months after tension-band wiring of the olecranon. J Shoulder Elbow Surg 19:e9–e11. doi: 10.1016/j.jse.2009.10.009 CrossRefPubMedGoogle Scholar
  13. 13.
    Lee SH, Han SB, Jeong WK, Park JH, Park SY, Patil S (2010) Ulnar artery pseudoaneurysm after tension band wiring of an olecranon fracture resulting in Volkmann’s ischemic contracture: a case report. J Shoulder Elbow Surg 19:e6–e8. doi: 10.1016/j.jse.2009.06.007 CrossRefPubMedGoogle Scholar
  14. 14.
    De Carli P, Gallucci GL, Donndorff AG, Boretto JG, Alfie VA (2009) Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: a case report. J Shoulder Elbow Surg 18:e40–e44. doi: 10.1016/j.jse.2009.02.005 CrossRefPubMedGoogle Scholar
  15. 15.
    Candal-Couto JJ, Williams JR, Sanderson PL (2005) Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures: evaluation of the transcortical K-wire technique. J Orthop Trauma 19:480–482CrossRefPubMedGoogle Scholar
  16. 16.
    Parker JR, Conroy J, Campbell DA (2005) Anterior interosseus nerve injury following tension band wiring of the olecranon. Injury 36:1252–1253CrossRefPubMedGoogle Scholar
  17. 17.
    Thumroj E, Jianmongkol S, Thammaroj J (2005) Median nerve palsy after operative treatment of olecranon fracture. J Med Assoc Thai 88:1434–1437PubMedGoogle Scholar
  18. 18.
    Siebenlist S, Torsiglieri T, Kraus T, Burghardt RD, Stöckle U, Lucke M (2010) Comminuted fractures of the proximal ulna–Preliminary results with an anatomically preshaped locking compression plate (LCP) system. Injury 41:1306–1311. doi: 10.1016/j.injury.2010.08.008 CrossRefPubMedGoogle Scholar
  19. 19.
    Hume MC, Wiss DA (1992) Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 285:229–235PubMedGoogle Scholar
  20. 20.
    Bailey CS, MacDermid J, Patterson SD, King GJ (2001) Outcome of plate fixation of olecranon fractures. J Orthop Trauma 15:542–548CrossRefPubMedGoogle Scholar
  21. 21.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefPubMedGoogle Scholar
  22. 22.
    Morrey BF, An KN, Chao EYS (1993) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 2nd edn. W.B. Saunders, Philadelphia, pp 86–89Google Scholar
  23. 23.
    Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD (2008) Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res 3:9. doi: 10.1186/1749-799X-3-9 CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Fyfe IS, Mossad MM, Holdsworth BJ (1985) Methods of fixation of olecranon fractures. An experimental mechanical study. J Bone Joint Surg Br 67:367–372PubMedGoogle Scholar
  25. 25.
    Gordon MJ, Budoff JE, Yeh ML, Luo ZP, Noble PC (2006) Comminuted olecranon fractures: a comparison of plating methods. J Shoulder Elbow Surg 15:94–99CrossRefPubMedGoogle Scholar
  26. 26.
    Erturer RE, Sever C, Sonmez MM, Ozcelik IB, Akman S, Ozturk I (2011) Results of open reduction and plate osteosynthesis in comminuted fracture of the olecranon. J Shoulder Elbow Surg 20:449–454CrossRefPubMedGoogle Scholar
  27. 27.
    Cervera-Irimia J, Tomè-Bermejo F, Gòmez-Bermejo MA, Holgado-Moreno E, Stratenweth EG (2012) Treatment of comminuted olecranon fractures with olecranon plate and structural iliac crest graft. Acta Orthop Belg 78:703–707PubMedGoogle Scholar
  28. 28.
    Ikeda M, Fukushima Y, Kobayashi Y, Oka Y (2001) Comminuted fractures of the olecranon. Management by bone graft from the iliac crest and multiple tension-band wiring. J Bone Joint Surg Br 83:805–808CrossRefPubMedGoogle Scholar
  29. 29.
    Anderson ML, Larson AN, Merten SM, Steinmann SP (2007) Congruent elbow plate fixation of olecranon fractures. J Orthop Trauma 21:386–393CrossRefPubMedGoogle Scholar
  30. 30.
    Wilson J, Bajwa A, Kamath V, Rangan A (2011) Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br 93:245–250. doi: 10.1302/0301-620X.93B2.24613 CrossRefPubMedGoogle Scholar
  31. 31.
    Buijze G, Kloen P (2009) Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 91:2416–2420. doi: 10.2106/JBJS.H.01419 CrossRefPubMedGoogle Scholar
  32. 32.
    van der Linden SC, van Kampen A, Jaarsma RL (2012) K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 21:405–411. doi: 10.1016/j.jse.2011.07.022 CrossRefPubMedGoogle Scholar
  33. 33.
    Villanueva P, Osorio F, Commessatti M, Sanchez-Sotelo J (2006) Tension-band wiring for olecranon fractures: analysis of risk factors for failure. J Shoulder Elbow Surg 15:351–356CrossRefPubMedGoogle Scholar
  34. 34.
    Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63:872–877PubMedGoogle Scholar
  35. 35.
    Hak DJ, Golladay GJ (2000) Olecranon fractures: treatment options. J Am Acad Orthop Surg 8:266–275PubMedGoogle Scholar
  36. 36.
    Cabanella ME, Morrey BF (1993) Fractures of the proximal ulna and olecranon. In: Morrey BF (ed) The elbow and its disorders. W.B. Saunders, Philadelphia, pp 407–408Google Scholar
  37. 37.
    Karlsson MK, Hasserius R, Karlsson C, Besjakov J, Josefsson PO (2002) Fractures of the olecranon: a 15- to 25-year followup of 73 patients. Clin Orthop Relat Res 403:205–212CrossRefPubMedGoogle Scholar
  38. 38.
    Simpson NS, Goodman LA, Jupiter JB (1996) Contoured LCDC plating of the proximal ulna. Injury 27:411–417CrossRefPubMedGoogle Scholar
  39. 39.
    Tejwani NC, Garnham IR, Wolinsky PR, Kummer FJ, Koval KJ (2002–2003) Posterior olecranon plating: biomechanical and clinical evaluation of a new operative technique. Bull Hosp Jt Dis 61:27–31Google Scholar
  40. 40.
    Karlsson MK, Hasserius R, Besjakov J, Karlsson C, Josefsson PO (2002) Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures. J Shoulder Elbow Surg 11:377–382 (erratum in: J Shoulder Elbow Surg 11:647)CrossRefPubMedGoogle Scholar
  41. 41.
    Lindenhovius AL, Brouwer KM, Doornberg JN, Ring DC, Kloen P (2008) Long-term outcome of operatively treated fracture-dislocations of the olecranon. J Orthop Trauma 22:325–331. doi: 10.1097/BOT.0b013e31817283f7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Luigi Tarallo
    • 1
  • Raffaele Mugnai
    • 1
  • Roberto Adani
    • 2
  • Francesco Capra
    • 3
  • Francesco Zambianchi
    • 1
  • Fabio Catani
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Department of Hand SurgeryUniversity Hospital of VeronaVeronaItaly
  3. 3.Alma Mater StudiorumUniversity of BolognaBolognaItaly

Personalised recommendations