Plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications

Abstract

Objective: Olecranon fractures are common injuries in patients of any age. The vast majority are treated with two operation techniques: a plate fixation (PF) or tension band wiring (TBW). The objective of this study is to compare the outcomes of surgically treated olecranon fractures with plate fixation or tension band wiring. We hypothesise that PF patients would show significantly inferior outcomes due to more complex injuries.

Patients and methods: Between 2010 and 2017, a total of 108 patients were treated with plate fixation and or tension band wiring. Clinical data of 40 surgically treated olecranon fractures were collected and analysed. Clinical and functional evaluations were performed using Mayo-Score, DASH-Score, Weseley -Score and subject elbow value (SEV). Furthermore, complication rates, time to return to work and operation duration were documented.

Results: The mean follow-up was 70.5 ± 45.6 months. Time of return to work was 6.5 ± 2.2 weeks in the TBW group and 10.9 ± 6,6 in the PF group (p = 0.372). The mean duration of surgery was 95.2 ± 47.0 min in the TBW group and 192.5 ± 113.0 min in the PF group (p = 0.001). In the TBW group, the mean hospitalisation period was 7.9 ± 10.1 days and 11.2 ± 9.8 days in the PF group. Revisions were required in 0.3 ± 0.6 of cases (0.2 ± 0.5 in TBE and 0.4 ± 0.7 in PF). The median DASH Score was 7.0 (3.6-13.7) in the TBW group and 12.1 (5.5-24.8) in the PF group (p = 0.948).

Conclusion: Tension band wiring and plate fixation are both practical treatment options with mostly positive outcomes, even though high complication rates can occur. There were no significant differences in either group concerning functional outcome or time back to work. The duration of surgery was significantly higher in the PF group, whereas the incidence of metalwork-associated complications was higher in the TBW group.

Keywords: Elbow fracture; Locking plate; Olecranon fixation; Olecranon fracture; Tension band wiring.

Fig. 1

Fracture of a 52-year-old male patient after bicycle accident. a: X-ray in lateral view. b: AP view before surgery. c: Status after TBW in lateral X-ray. d: Status after TBW in AP view.

Fig. 2

X-ray of a Mayo IIIb fracture of a 49-year-old male patient after ladder accident. a: Lateral X-ray after injury. b: Lateral view after plate fixation. c: AP view after surgery.

Fig. 3

Outcome analysis. a: DASH Score in TBW and PF group. b: Subjective elbow function according to operation technique. c: Time to return to work in weeks in both groups. d: Wesley score in three categories form fair to excellent in both operational groups.