Skip to main content

Olecranon Fractures

  • Chapter
  • First Online:
Essential Biomechanics for Orthopedic Trauma
  • 1114 Accesses

Abstract

Olecranon fractures are very common and, in most cases, require surgery, using either tension band or plate fixation. Studies comparing both methods have failed to show any significant clinical difference, and tension band fixation remains a cost-effective treatment option for simple fractures. However, it must be performed according to proper fixation methods, which is more difficult than it appears to be at first glance.

Indeed, each fragment should be fixed in the case of an olecranon fracture to recreate a stable and mobile elbow. Tension band surgical fixation, using K-wires and metallic wires, is a good surgical option in cases of simple transverse fractures, without elbow instability or dislocation. In order to accomplish this technique, the surgeon requires lateral decubitus positioning, safe surgical approach, anatomic reduction of each fragment with independent small threaded wires, and tension band fixation of the tricipital fragment. Complex fractures and fracture dislocations are preferably treated with a designated periarticular locking plate.

This chapter will present a descriptive classification of olecranon fractures, clarify the indication for tension band in olecranon fractures with illustrative cases, and review surgical tips to increase the solidity of olecranon tension bands, based on biomechanical and clinical studies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Wood T, Thomas K, Farrokhyar F, Ristevski B, Bhandari M, Petrisor B. A survey of current practices and preferences for internal fixation of displaced olecranon fractures. Can J Surg. 2015;58(4):250–6.

    Article  Google Scholar 

  2. Pauwels F. Biomechanics of the locomotor apparatus. 1st ed. Berlin/Heidelberg/New York: Springer; 1980.

    Book  Google Scholar 

  3. Hak DJ, Stewart RL. 3.2.3 Tension band principle. In: Rüedi TP, Buckley RE, Moran CG, editors. AO principles of fracture management. 2nd ed. Stuttgart: Thieme; 2007. https://www2.aofoundation.org/wps/portal/!ut/p/a0/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAzMjfULsh0VAbWjLW0!/?bone=Radius&segment=Distal&showPage=F&contentUrl=srg/popup/further_reading/PFxM2/323_Tension_bnd.jsp. Accessed 25 Oct 2018.

    Google Scholar 

  4. Wilson J, Bajwa A, Kamath V, Rangan A. Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br. 2011;93(2):245–50.

    Article  CAS  Google Scholar 

  5. Brink PR, Windolf M, de Boer P, Brianza S, Braunstein V, Schwieger K. Tension band wiring of the olecranon: is it really a dynamic principle of osteosynthesis? Injury. 2013;44(4):518–22.

    Article  CAS  Google Scholar 

  6. Rouleau DM, Faber KJ, Athwal GS. The proximal ulna dorsal angulation: a radiographic study. J Shoulder Elb Surg. 2010;19(1):26–30.

    Article  Google Scholar 

  7. Puchwein P, Schildhauer TA, Schöffmann S, Heidari N, Windisch G, Pichler W. Three-dimensional morphometry of the proximal ulna: a comparison to currently used anatomically preshaped ulna plates. J Shoulder Elb Surg. 2012;21(8):1018–23.

    Article  Google Scholar 

  8. Sandman E, Canet F, Petit Y, Laflamme GY, Athwal GS, Rouleau DM. Radial head subluxation after malalignment of the proximal ulna: a biomechanical study. J Orthop Trauma. 2014;28(8):464–9.

    Article  Google Scholar 

  9. Chapleau J, Balg F, Harvey EJ, Ménard J, Vauclair F, Laflamme GY, et al. Impact of olecranon fracture malunion: study on the importance of PUDA (proximal ulna dorsal angulation). Injury. 2016;47(11):2520–4.

    Article  Google Scholar 

  10. Amini MH, Azar FM, Wilson BR, Smith RA, Mauck BM, Throckmorton TW. Comparison of outcomes and costs of tension-band and locking-plate osteosynthesis in transverse olecranon fractures: a matched-cohort study. Am J Orthop (Belle Mead NJ). 2015;44(7):E211–5.

    Google Scholar 

  11. Snoddy MC, Lang MF, An TJ, Mitchell PM, Grantham WJ, Hooe BS, et al. Olecranon fractures: factors influencing re-operation. Int Orthop. 2014;38(8):1711–6.

    Article  Google Scholar 

  12. Tarallo L, Mugnai R, Adani R, Capra F, Zambianchi F, Catani F. Simple and comminuted displaced olecranon fractures: a clinical comparison between tension band wiring and plate fixation techniques. Arch Orthop Trauma Surg. 2014;134(8):1107–14.

    Article  Google Scholar 

  13. DelSole EM, Pean CA, Tejwani NC, Egol KA. Outcome after olecranon fracture repair: does construct type matter? Eur J Orthop Surg Traumatol. 2016;26(2):153–9.

    Article  Google Scholar 

  14. Liñán-Padilla A, Cáceres-Sánchez L. Type II olecranon fractures in patients over 65. Tension band or pre-formed plate? Analysis and results. Rev Esp Cir Ortop Traumatol. 2017;61(5):339–42.

    PubMed  Google Scholar 

  15. Schliemann B, Raschke MJ, Groene P, Weimann A, Wähnert D, Lenschow S, Kösters C. Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo type IIA olecranon fractures. Acta Orthop Belg. 2014;80(1):106–11.

    PubMed  Google Scholar 

  16. Ren YM, Qiao HY, Wei ZJ, Lin W, Fan BY, Liu J, et al. Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2016;11(1):137.

    Article  Google Scholar 

  17. Francis T, Washington T, Srivastava K, Moutzouros V, Makhni EC, Hakeos W. Societal costs in displaced transverse olecranon fractures: using decision analysis tools to find the most cost-effective strategy between tension band wiring and locked plating. J Shoulder Elb Surg. 2017;26(11):1995–2003.

    Article  Google Scholar 

  18. Claessen FMAP, van den Bekerom MPJ, van Dijk CN, Goslings JC, Kerkhoffs GMMJ, Doornberg JN. Shoulder elbow platform. Tension band wiring for simple olecranon fractures: evaluation of surgical technique. J Orthop Traumatol. 2017;18(3):275–81. Erratum: J Orthop Traumatol. 2018;19(1):16.

    Google Scholar 

  19. Schneider MM, Nowak TE, Bastian L, Katthagen JC, Isenberg J, Rommens PM, et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. Int Orthop. 2014;38(4):847–55.

    Article  Google Scholar 

  20. Gruszka D, Arand C, Nowak T, Dietz SO, Wagner D, Rommens P. Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study. Int Orthop. 2015;39(5):955–60.

    Article  Google Scholar 

  21. von Rüden C, Woltmann A, Hierholzer C, Trentz O, Bühren V. The pivotal role of the intermediate fragment in initial operative treatment of olecranon fractures. J Orthop Surg Res. 2011;6:9.

    Article  Google Scholar 

  22. Rouleau DM, Sandman E, van Riet R, Galatz LM. Management of fractures of the proximal ulna. J Am Acad Orthop Surg. 2013;21(3):149–60. Review.

    PubMed  Google Scholar 

  23. Niéto H, Billaud A, Rochet S, Lavoinne N, Loubignac F, Pietu G, et al. Proximal ulnar fractures in adults: a review of 163 cases. Injury. 2015;46(Suppl 1):S18–23.

    Article  Google Scholar 

  24. Suresh SS. Management of comminuted olecranon fractures with precut K-wires and tension band wiring. Tech Hand Up Extrem Surg. 2009;13(2):82–4. Review.

    Article  CAS  Google Scholar 

  25. Saeed ZM, Trickett RW, Yewlett AD, Matthews TJ. Factors influencing K-wire migration in tension-band wiring of olecranon fractures. J Shoulder Elb Surg. 2014;23(8):1181–6.

    Article  Google Scholar 

  26. Özsoy MH, Kızılay O, Günenç C, Özsoy A, Demiryürek D, Hayran M, et al. Modified tension band wiring technique for olecranon fractures: where and how should the K-wires be inserted to avoid articular penetration? Acta Orthop Traumatol Turc. 2015;49(2):190–6.

    PubMed  Google Scholar 

  27. Catalano LW 3rd, Crivello K, Lafer MP, Chia B, Barron OA, Glickel SZ. Potential dangers of tension band wiring of olecranon fractures: an anatomic study. J Hand Surg Am. 2011;36(10):1659–62.

    Article  Google Scholar 

  28. Willinger L, Lucke M, Crönlein M, Sandmann GH, Biberthaler P, Siebenlist S. Malpositioned olecranon fracture tension-band wiring results in proximal radioulnar synostosis. Eur J Med Res. 2015;20:87.

    Article  Google Scholar 

  29. De Carli P, Gallucci GL, Donndorff AG, Boretto JG, Alfie VA. Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: a case report. J Shoulder Elb Surg. 2009;18(3):e40–4.

    Article  Google Scholar 

  30. Lee HJ, Jung JW, Cho DW, Jeon IH. Morphometric analysis of the proximal ulna using three-dimensional computed tomography and computer-aided design: varus, dorsal, and torsion angulation. Surg Radiol Anat. 2014;36(8):763–8.

    Article  Google Scholar 

  31. Rompen JC, Vos GA, Verheyen CC. Acute ischemia of the hand seven months after tension-band wiring of the olecranon. J Shoulder Elb Surg. 2010;19(3):e9–11.

    Article  CAS  Google Scholar 

  32. Huang TW, Wu CC, Fan KF, Tseng IC, Lee PC, Chou YC. Tension band wiring for olecranon fractures: relative stability of Kirschner wires in various configurations. J Trauma. 2010;68(1):173–6.

    Article  Google Scholar 

  33. Mauffrey CP, Krikler S. Surgical techniques: how I do it? Open reduction and tension band wiring of olecranon fractures. Injury. 2009;40(4):461–5.

    Article  CAS  Google Scholar 

  34. Powell AJ, Farhan-Alanie OM, Bryceland JK, Nunn T. The treatment of olecranon fractures in adults. Musculoskelet Surg. 2017;101(1):1–9.

    Article  CAS  Google Scholar 

  35. Lalliss SJ, Branstetter JG. The use of three types of suture and stainless steel wire tension banding for the fixation of simulated olecranon fractures: a comparison study in cadaver elbows. J Bone Joint Surg Br. 2010;92(2):315–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dominique M. Rouleau .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rouleau, D.M. (2020). Olecranon Fractures. In: Crist, B., Borrelli Jr., J., Harvey, E. (eds) Essential Biomechanics for Orthopedic Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-36990-3_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-36990-3_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-36989-7

  • Online ISBN: 978-3-030-36990-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics