Revision Olecranon Fixation: Is Tension Band Wiring the Solution? A Case Series and Review of the Literature

The optimal revision construct for failed olecranon fracture fixation is controversial. Here, we aim to review existing revision techniques and describe tension band wiring as a surgical option for these challenging scenarios and to evaluate its clinical and radiographic outcomes.

This retrospective case series was performed at an urban, university-based, level-1 trauma center. Patients aged 18 to 65 years who underwent revision fixation of their olecranon fracture using tension band wiring were included. The study data were collected through a retrospective chart review and review of the existing radiographic studies. Primary outcome measure was mechanical failure. Secondary outcome measures included nonunion, malunion, medical, and surgical complications. Functional outcome was determined by range of motion and restoration of extensor mechanism strength.

A total of five patients were included in this study. Causes for revision were acute implant failure (n = 2), aseptic nonunion (n = 1), and infected nonunion (n = 2). All patients eventually achieved bony union after revision. Two patients required an additional surgery because of Kirschner wire migration (n = 1) and symptomatic implant (n = 1). Average flexion was 126° (range 110 to 135) and average extension was 18° (range 5 to 30). All patients experienced restoration of extensor mechanism with full strength and returned to their previous working status. No other mechanical failures, surgical complications, or medical complications occurred.

Early results of revision open reduction and internal fixation for failed olecranon fracture fixation using tension band wiring demonstrated favorable outcomes and low complication rates. This technique may be used for revision of failed olecranon fixation.