Complications in Olecranon Fracture Surgery: A Comparison of Tension Band Vs. Plate Osteosynthesis

Document Type : RESEARCH PAPER


1 Southern California Permanente Medical Group,Kaiser Permanente, South Bay Medical Center, Harbor City, CA, USA

2 Southern California Permanente Medical Group, Kaiser Permanente, Downey Medical Center, Downey, California, USA

3 Division of Biostatistics, Kaiser Permanente Department of Research & Evaluation, Pasadena, California, USA

4 Coastline Orthopaedic Associates, Fountain Valley, California, USA

5 Kaiser Permanente School of Medicine, Pasadena, California, USA

6 Upper Extremity Surgeon, Kaiser Permanente, South Bay Medical Center, Harbor City, California, USA


wiring (TBW) versus plate osteosynthesis (POS) in the treatment of olecranon fractures.
Methods: 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 two cohorts:
fractures fixed using the tension band technique and fractures fixed using plate osteosynthesis. The study was limited
to the Orthopedic Trauma Association classification of olecranon fracture type 21-B1, with subtypes 1-3. Outcome
measures were loss of fracture fixation requiring revision, postoperative 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.
Results: A total of 321 olecranon fractures were included (median age: 61 years old, 57 % female); 153 participants
were treated with TBW, and 168 patients with POS. There was one failure in the TBW group and two 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. The 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.
Conclusion: In this large study comparing POS and TBW for 21-B1 olecranon fractures, no difference in fixation
failure, infection, or postoperative stiffness was noted. A significantly greater risk of symptomatic hardware occurred
in TBW. 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: III


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Volume 10, Issue 10
October 2022
Pages 863-870
  • Receive Date: 17 September 2021
  • Revise Date: 21 November 2021
  • Accept Date: 13 December 2021
  • First Publish Date: 15 September 2022