Tension Band Wiring Versus Precontoured Plate Fixation for 2-Part and Multifragmented Olecranon Fractures: A...

Area of Science:

• Orthopedic surgery
• Traumatology
• Surgical techniques

Background:

• Olecranon fractures are common and require effective treatment.
• Comparing fixation methods is crucial for optimal patient outcomes.

Purpose of the Study:

• To compare tension band wiring (TBW) versus precontoured plate fixation (PF) for 2-part and multifragmented olecranon fractures.
• To assess functional outcomes using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score.

Main Methods:

• A randomized controlled trial included 200 patients (18-75 years) with isolated, displaced olecranon fractures.
• Patients were allocated to TBW (n=100) or PF (n=100) and followed for 24 months.
• The primary outcome was the QuickDASH score at 12 months; a noninferiority design was used.

Main Results:

• Both TBW and PF groups achieved a median QuickDASH score of 5 at 12 months, demonstrating noninferiority.
• TBW procedures were significantly shorter (64 min vs. 88 min, p < 0.01).
• Secondary surgical procedures were more frequent in the TBW group (49 vs. 34 patients, p=0.04), primarily for hardware irritation.

Conclusions:

• Tension band wiring is a noninferior surgical option for treating isolated, displaced 2-part and multifragmented olecranon fractures compared to plate fixation.
• While TBW offers a shorter operative time, surgeons should anticipate a higher rate of hardware-related complications requiring secondary procedures.
• Plate fixation may be preferred when minimizing secondary surgeries is a priority.