Double Cerclage Wiring (DCW) of Displaced Stable Olecranon Fractures

Several methods of surgically treating displaced, ulno-humerally stable olecranon fractures (Mayo type 2a and 2b) have been suggested. Cerclage wires have been used for at least a century to achieve fracture fixation but have been replaced by tension band wiring or plate fixation as the commonly recognized "gold standard" treatments. Thin soft tissues and migrating K-wires result in high complication rates following these 2 methods. We suggest double cerclage wiring as an alternative method that allows for the omission of K-wires. The method can be used for the same indications as tension band wiring: Mayo type 2a and 2b fractures. Two cerclages are placed, in figure-of-eight and figure-of-zero configurations, respectively, through separate drill holes distally and through the triceps tendon proximally. In a retrospective study, the reoperation rate and complication rate were twice as high following tension band wiring compared with double cerclage wiring (27% vs. 13% and 45% vs. 18%, respectively). An ongoing RCT will provide more robust evidence, but current studies indicate that double cerclage wiring is a safe and possibly superior alternative to tension band wiring.