Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jan 30;5(3):487-496.
doi: 10.1016/j.xrrt.2024.12.016. eCollection 2025 Aug.

Tension band wiring and plate fixation for Olecranon fractures: a systematic review and meta-analysis

Mikhail A Bethell  1 , Tom R Doyle  1   2 , Eoghan T Hurley  1 , Harvey Allen  1 , Tyler S Pidgeon  1 , Christian A Péan  1 , Oke Anakwenze  1 , Christopher S Klifto  1
Affiliations
Review

Tension band wiring and plate fixation for Olecranon fractures: a systematic review and meta-analysis

Mikhail A Bethell et al. JSES Rev Rep Tech. .

Abstract

Background: The purpose of this study is to perform a systematic review of the literature comparing the utilization of tension-band wiring (TBW) and plate fixation for the surgical management of olecranon fractures.

Methods: A systematic search of articles in PubMed and Embase databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing TBW to plate fixation for olecranon fractures were included. All statistical analyses were performed using Review Manager. A P value of < .05 was considered to be statistically significant.

Results: Twenty studies with 2164 patients were included. There were no significant differences in the Disabilities of the Arm, Shoulder, and Hand score (12.3 ± 4.7 vs. 12.1 ± 4.9, P = .23), Mayo Elbow Performance score (92.0 ± 5.4 vs. 92.3 ± 3.7, P = .65), or overall range of motion (P = .15) between TBW and plate fixation. Although extension was statistically significant (7° ± 2° vs. 9° ± 2°, P = .05), the 2-degree difference is not clinically meaningful. There were significantly lower rates of loss of reduction (6.6% vs. 2.6%, P < .01), implant removal (31.4% vs. 14.3%, P < .01), overall reoperation (35.3% vs. 17.7%, P < .01), and complications (45.1% vs. 27.6%, P < .01) after plate fixation. Finally, there were no significant differences in wound breakdown (4.4% vs. 3.9%, P = .73) and infection rates (4.1% vs. 4.0%, P = .86).

Conclusion: This study highlights that while TBW and plate fixation offer similar functional outcomes for olecranon fractures, plate fixation demonstrates superior results in terms of lower rates of fixation failure, implant removal, reoperation, and overall complications compared to TBW. These findings suggest that plate fixation should be preferred for surgical management for most patients.

Keywords: Fracture; Meta-analysis; Olecranon; Plate fixation; Systematic review; Tension band wiring.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flowchart (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).
Figure 2
Figure 2
Forest plot showing no difference in the DASH scores between TBW and plate fixation. DASH, Disabilities of the Arm, Shoulder, and Hand; TBW, tension-band wiring; CI, confidence interval.
Figure 3
Figure 3
Forest plot showing no difference in the MEPS scores between TBW and plate fixation. MEPS, Mayo Elbow Performance score; TBW, tension-band wiring; CI, confidence interval.
Figure 4
Figure 4
Forest plots showing no difference in range of motion between TBW and plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 5
Figure 5
Forest plot of loss of fracture reduction with TBW compared to plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 6
Figure 6
Nonunion with TBW compared to plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 7
Figure 7
Forest plots showing no difference with wound breakdown and infections between TBW and plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 8
Figure 8
Forest plot of implant removal with TBW compared to plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 9
Figure 9
Forest plot of the overall reoperation rate with TBW compared to plate fixation. TBW, tension-band wiring; CI, confidence interval.
Figure 10
Figure 10
Forest plot of overall complications with TBW compared to plate fixation. TBW, tension-band wiring; CI, confidence interval.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Amini M.H., Azar F.M., Wilson B.R., Smith R.A., Mauck B.M., Throckmorton T.W. 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:E211–E215. - PubMed
    1. Avisar E., Essa A., Gutman-Tirosh A., Dahan M., Assaraf E., Persitz J. Is tension band wire fixation superior to plate fixation for simple displaced olecranon fractures? A randomized trial with median follow-up of 7.5 years. Clin Orthop Relat Res. 2023;482:127–133. doi: 10.1097/CORR.0000000000002832. - DOI - PMC - PubMed
    1. Bailey C.S., MacDermid J., Patterson S.D., King G.J. Outcome of plate fixation of olecranon fractures. J Orthop Trauma. 2001;15:542–548. - PubMed
    1. Buijze G.A., Blankevoort L., Tuijthof G.J., Sierevelt I.N., Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg. 2010;130:459–464. doi: 10.1007/s00402-009-0980-z. - DOI - PMC - PubMed
    1. Caglar C., Akcaalan S., Ozaslan H.I., Yagar H., Ugurlu M. Comparison of tension band wiring and plate fixation in mayo type 2A olecranon fractures. Jt Dis Relat Surg. 2021;32:85–92. doi: 10.5606/ehc.2021.75812. - DOI - PMC - PubMed

LinkOut - more resources