Document Type : RESEARCH PAPER
Department of Clinical Sciences, Kaiser Permanente School of Medicine, Pasadena, California
Coastline Orthopedic Associates
Kaiser Permanente Bernard J. Tyson School of Medicine
The purpose of this study is to compare the incidence of complications associated with tension band wiring (TBW) versus plate osteosynthesis (POS) in the treatment of olecranon fractures.
We performed a retrospective cohort study of operatively treated adult olecranon fractures from an integrated healthcare system by multiple surgeons from January 2008 to December 2011. Patients were divided into 2 cohorts: fractures fixed using the tension band technique and fractures fixed using plate osteosynthesis. The study was limited to OTA classification olecranon fracture type 21-B1, with subtypes 1-3. Outcome measures were loss of fracture fixation requiring revision, post-operative infection, stiffness requiring surgery and symptomatic hardware removal (HWR). Univariate and multivariable logistic regressions were performed to test the associations between the type of internal fixation and outcomes.
321 olecranon fractures were included (median age 61, 57 % female); 153 treated with TBW and 168 with POS. There was 1 failure in the TBW group and 2 in the POS group (p=0.62). There were no significant differences in the infection rates (TBW 5%, POS 9%, p=0.20) and no reoperations for stiffness. HWR occurred significantly more often in TBW (29%) than in POS (14%) (OR=0.39, p=0.001). The association between POS and decreased HWR remained highly significant (OR=0.40, p=0.003) after adjusting for clinical variables.
In this large study comparing POS and TBW for 21-B1 olecranon fractures, no difference in fixation failure, infection or postoperative stiffness was noted. TBW had significantly greater risk of symptomatic hardware. These findings may assist surgeons and patients in considering the risks and benefits of TBW and POS as treatment options for displaced olecranon fractures.
Level of evidence – Level III Retrospective Study