Suture tension band fixation reduces hardware complications in olecranon fractures: a comparative study

Olecranon fractures requiring open reduction with internal fixation commonly undergo either plate fixation or tension band wire fixation. We describe surgical and post-operative functional outcomes after a novel variation of the tension banding technique utilizing Kirschner wires (K-wires) with eyelet holes and suture, compared to those that underwent plate fixation and tension band wire fixation. We hypothesized that suture tape tension banding would demonstrate noninferior surgical and functional outcomes.

A retrospective review was conducted of all patients with Mayo IIA olecranon fractures who underwent operative transverse olecranon fracture fixation at a single institution between July 2017 and October 2023 with plate fixation, suture tape tension band fixation, or wire tension band fixation. Intraoperative data, patient-reported outcome measures, and functional outcomes were collected. Radiographs taken at least 12 weeks post-operatively were interpreted by the senior author.

In total, 43 patients underwent an open reduction with internal fixation for isolated olecranon fractures: 19 plate fixations, 16 suture tension band (STB), and 8 wire tension bands. The STB cohort had significantly shorter surgery times (68.2 min ±13) compared to the plate fixation (86.6 ± 19) and tension band with wire (88.0 ± 19) cohorts (P = .005). There was no difference in pain, functional outcomes, or range of motion among the 3 cohorts. Radiographs demonstrated 100% union rates for all patients in each cohort. There were no complications in the plate or STB groups, while 1 patient in the wire tension band had symptomatic hardware that required removal.

This paper reports on a novel technique of STB using K-wires with eyelets. This technique appears to be associated with comparable outcomes to the 2 traditional techniques, including plate fixation and tension band fixation with K-wires in this preliminary study. However, it also required less overall surgical time. Future studies should focus on the long-term outcomes of this technique, as compared to traditional and more established techniques to treat olecranon fractures.