Olecranon Fracture Repair: A Comparative Analysis of 4 Surgical Techniques

Olecranon fractures are common injuries and may be indicated for open reduction and internal fixation (ORIF). Surgical techniques include plates and screws, intramedullary screw, Kirschner wire with tension band (KWTB), and all-suture fixation. The purpose of this study was to compare surgical and patient-reported outcomes between these fixation techniques.

Adult patients who underwent surgery were retrospectively queried (January 2016-December 2020). Demographics, comorbidities, fracture characteristics, surgical details, elbow range of motion (ROM), incidence and time to radiographic healing, reoperations, complications, and patient-reported outcomes were collected.

A total of 426 patients met inclusion criteria (plates and screws: 315, intramedullary screw: 27, KWTB: 64, all-suture: 20). Comminuted fractures were predominantly managed using ORIF with plates and screws (45.4%; P < .001). In the postoperative period, KWTB patients experienced hardware loosening (7.81%; P = .049), reoperation (25.0%; P = .031), and delayed radiographic healing (129 ± 226 days; P = .013) at higher rates. Logistic regression demonstrated that comminuted fractures were less likely to be repaired using intramedullary screw fixation or KWTB in comparison with ORIF with plates and screws. Linear regression also found that intramedullary screw fixation was associated with a significant decrease in postoperative elbow extension ROM.

This study found that the 4 surgical techniques for olecranon fracture fixation provided favorable postoperative and patient-reported outcomes while identifying differences in tension band type, fracture characteristics, and complications that may influence surgical decision-making. The otherwise comparable outcomes suggest that surgeons may repair olecranon fractures using their technique of choice without significant additional risk of adverse events.