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


  1. References

    1. Rommens PM, Kuchle R, Schneider RU, Reuter M.Olecranon fractures in adults: factors influencing outcome. Injury 2004, 35(11):1149-1157. doi: 10.1016/j.injury.2003.12.002.
    2. Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Orthop Trauma. 1997; 11(8):545-50. doi: 10.1097/00005131-199711000-00001.
    3. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000; 8:266-75. doi: 10.5435/00124635-200007000-00007.
    4. Tejwani NC, Garnham IR, Wolinsky PR, Kummer FJ, Koval KJ. Posterior olecranon plating: biomechanical and clinical evaluation of a new operative technique. Bull Hosp Jt Dis 2002, 61(1-2):27-31.
    5. 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 doi: 10.1302/0301-620X.93B2.24613.
    6. Horner SR, Sadasivan KK, Lipka JM, Saha S. Analysis of mechanical factors affecting fixation of olecranon fractures. Orthopedics. 1989; 12:1469-72. doi: 10.3928/0147-7447-19891101-12.
    7. Schliemann B, Raschke MJ, Groene P, et al. 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.
    8. 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. doi: 10.1007/s00402-014-2021-9
    9. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. Orthop Trauma. 2007, 21(10 Suppl):S1-133. doi: 10.1097/00005131-200711101-00001.
    10. Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD. Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long-term functional outcome study. J Orthop Surg Res. 2008 22; 3:9. doi: 10.1186/1749-799X-3-9.   
    11. Horne JG, Tanzer TL. Olecranon fractures: a review of 100 cases. J Trauma 1981, 21(6):469-472.
    12. Villanueva P, Osorio F, Commessatti M, Sanchez-Sotelo J. Tension-band wiring for olecranon fractures: analysis of risk factors for failure. J Shoulder Elbow Surg 2006, 15(3):351-356. doi 10.1016/j.jse.2005.08.002.
    13. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am. 2009; 91(10):2416-20. doi: 10.2106/JBJS.H.01419.
    14. Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 1992; 285:229–35.
    15. Larsen E, Jensen CM. Tension-band wiring of olecranon fractures with nonsliding pins. Report of 20 cases. Acta Orthop Scand 1991, 62(4):360-362. doi 10.3109/17453679108994470.
    16. Duckworth AD, Clement ND, White TO, Court-Brown CM, McQueen MM. Plate Versus Tension-Band Wire Fixation for Olecranon Fractures: A Prospective Randomized Trial. J Bone Joint Surg Am. 2017; 99(15):1261-1273. doi: 10.2106/JBJS.16.00773.
    17. Gathen M, Jaenisch M, Peez C, et al. Plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications. J Orthop. 2019; 18:69-75. doi: 10.1016/j.jor.2019.09.017.
    18. Koziarz A, Woolnough T, Oitment C, Nath S, Johal H. Surgical Management for Olecranon Fractures in Adults: A Systematic Review and Meta-analysis. Orthopedics. 2019; 42(2):75-82. doi: 10.3928/01477447-20190221-03.
    19. Phadnis JS, Vaughan A, Luokkala T, Peters J, Watson JJ, Watts A. Comparison of all suture fixation with tension band wiring and plate fixation of the olecranon. Shoulder Elbow. 2020; 12(6):414-421. doi: 10.1177/1758573219831662.
    20. Powell AJ, Farhan-Alanie OM, McGraw IWW. Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reope-rations and economics. Musculoskelet Surg. 2019; 103(2):155-160. doi: 10.1007/s12306-018-0556-6.
    21. King GJ, Lammens PN, Milne AD, Roth JH, Johnson JA. Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study. J Shoulder Elbow Surg 1996, 5(6):437-441. doi 10.1016/S1058-2746(96)80015-2.
    22. DelSole EM, Egol KA, Tejwani NC. Construct Choice for the Treatment of Displaced, Comminuted Olecranon Fractures: are Locked Plates Cost Effective? Iowa Orthop J. 2016; 36:59-63.
    23. 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 Elbow Surg. 2017; 26(11):1995-2003. doi: 10.1016/j.jse.2017.07.017.
    24. Tan BYJ, Pereira MJ, Ng J, Kwek EBK. The ideal implant for Mayo 2A olecranon fractures? An economic evaluation. J Shoulder Elbow Surg. 2020; 29(11):2347-2352. doi: 10.1016/j.jse.2020.05.035.
    25. Tull F, Borrelli J Jr. Soft-tissue injury associated with closed fractures: evaluation and management. J Am Acad Orthop Surg 2003; 11:431–8. doi: 10.5435/00124635-200311000-00007.
    26. Midtgaard KS, Søreide E, Brattgjerd JE, Moatshe G, Madsen JE, Flugsrud GB. Biomechanical comparison of tension band wiring and plate fixation with locking screws in transverse olecranon fractures. J Shoulder Elbow Surg. 2020; 29(6):1242-1248. doi: 10.1016/j.jse.2020.01.079.
    27. Van der Linden, SC, van Kampen A, Jaarsma RL. K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in the surgical treatment of olecranon fractures. J Shoulder Elbow Surg. 2012(3):405-11. doi: 10.1016/j.jse. 2011.07.022.