Olecranon Fractures: Patterns, Fixation Types, and Outcomes

Prominent metalwork remains a common source of postoperative discomfort following fixation of olecranon fractures and often leads to elective implant removal despite successful union. This study aimed to assess the incidence and pattern of symptomatic hardware prominence among different fixation methods involving tension band wiring (TBW), plate fixation, and suture constructs in a tertiary trauma center.

A retrospective review was conducted of adult patients who underwent operative fixation for olecranon fractures at the Queen Elizabeth Hospital, Birmingham, between January 2021 and July 2025. Patients with a minimum follow-up of 12 weeks were included. Both open and closed fractures were analyzed. Fixation methods included TBW, plate fixation using pre-contoured or hook plates, and high-strength fiber-suture constructs. The primary outcome was the reoperation rate, along with other fixation-related complications. Data were analyzed using Fisher's exact test, with p<0.05 considered statistically significant.

Of the 95 patients, 62 met the inclusion criteria (30 males, 32 females; mean age 57 years). The mean follow-up was 46 weeks (range, 3-42 months). TBW was used in 11 cases, plate fixation in 46, and suture fixation in five. A total of 22 patients experienced complications, of which 15 were due to prominent metalwork. Other complications requiring surgery included nonunion (1), synostosis (1), muscle hernia (1), and revision of radial head replacement (1). Three patients with loss of reduction did not undergo further surgery due to subsequent functional improvement. Sixteen patients had open fractures, with no postoperative infections noted. Of the 15 patients with prominent metalwork, 11 underwent implant removal (three in the TBW group and eight in the plating group). There was a difference in the incidence of removal of symptomatic metalwork between TBW (3/11, 27%) and plating (8/46, 17%), although the overall rate of symptomatic metalwork was similar in both groups (27% vs. 26%, respectively).

While both TBW and plate fixation provide stable fixation and reliable union, prominent metalwork remains a frequent postoperative issue and the primary reason for secondary surgery. Careful implant selection, meticulous soft‑tissue handling, and patient counseling are essential to minimize postoperative discomfort and optimize outcomes.