Cerclage Fixation Without K-wires is Associated with Fewer Complications and Reoperations Compared with Tension Band Wiring in Stable Displaced Olecranon Fractures in Elderly Patients

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 Jul 8

PMID 34236459

Citations 1

Authors

Daniel Wenger

Gustav Cornefjord

Cecilia Rogmark

Affiliations

Soon will be listed here.

Abstract

Introduction: Tension band wiring of olecranon fractures has high reported rates of complications and reoperations. We aimed to compare classic tension band wiring to cerclage fixation without K-wires in the treatment of displaced olecranon fractures in elderly patients. The primary outcome was reoperation. Secondary outcomes included complications and patient reported outcomes. Outcomes following non-operative treatment were also studied.

Materials And Methods: Patients aged > 69 years presenting with Mayo class 2a and 2b olecranon fractures at our institution from 2004 through 2016 (n = 239) were eligible for study. Fracture type, treatment method, complications and reoperations were assessed from radiographs and hospital files. QuickDASH surveys were collected by mail.

Results: Patients operated with tension band wire technique had more reoperations (p value 0.03): relative risk (RR) 2.2 (CI 1.08-4.3), odds ratio (OR) 2.6 (CI 1.05-6.4), and complications (p value 0.001): RR 2.5 (CI 1.51-4.1), OR 3.7 (CI 1.67-8.2), compared with those operated with cerclage technique. Non-operative treatment yielded similar complication (p value 0.2) and reoperation rates (p value 0.06) as cerclage fixation. The answer rate was insufficient to compare QuickDASH scores between treatments methods.

Conclusions: In patients 70 years and older undergoing cerclage fixation for displaced stable olecranon fractures (Mayo class 2), the reoperation and complications rates were less than half of those in patients undergoing TBW fixation. Non-operative treatment yielded similar reoperation and complication rates to cerclage fixation, in selected cases.

Level Of Evidence: III-retrospective comparative cohort study.

Citing Articles

The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial.

Cornefjord G, Kostogiannis I, Rogmark C, Jerrhag D, Wenger D Trials. 2023; 24(1):559.

PMID: 37641082 PMC: 10464474. DOI: 10.1186/s13063-023-07566-9.

References

Romero J, Miran A, Jensen C . Complications and re-operation rate after tension-band wiring of olecranon fractures. J Orthop Sci. 2000; 5(4):318-20. DOI: 10.1007/s007760070036. View

Hak D, Golladay G . Olecranon fractures: treatment options. J Am Acad Orthop Surg. 2000; 8(4):266-75. DOI: 10.5435/00124635-200007000-00007. View

Beaton D, Wright J, Katz J . Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am. 2005; 87(5):1038-46. DOI: 10.2106/JBJS.D.02060. View

Roukoz S, Bayoud W . WIRELESS TENSION BAND WIRING FOR OLECRANON FRACTURES. Case Series. J Med Liban. 2017; 64(3):160-3. DOI: 10.12816/0031525. View

Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Pournaras J . Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res. 2008; 3:9. PMC: 2265682. DOI: 10.1186/1749-799X-3-9. View

Karlsson M, Hasserius R, Besjakov J, Karlsson C, Josefsson P . Comparison of tension-band and figure-of-eight wiring techniques for treatment of olecranon fractures. J Shoulder Elbow Surg. 2002; 11(4):377-82. DOI: 10.1067/mse.2002.124548. View

Snoddy M, Lang M, An T, Mitchell P, Grantham W, Hooe B . Olecranon fractures: factors influencing re-operation. Int Orthop. 2014; 38(8):1711-6. PMC: 4115120. DOI: 10.1007/s00264-014-2378-y. View

Duckworth A, Clement N, Aitken S, Court-Brown C, McQueen M . The epidemiology of fractures of the proximal ulna. Injury. 2011; 43(3):343-6. DOI: 10.1016/j.injury.2011.10.017. View

Powell A, Farhan-Alanie O, McGraw I . Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reoperations and economics. Musculoskelet Surg. 2018; 103(2):155-160. DOI: 10.1007/s12306-018-0556-6. View

10.

Iordens G, Den Hartog D, Tuinebreijer W, Eygendaal D, Schep N, Verhofstad M . Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation; validation study alongside the multicenter FuncSiE trial. PLoS One. 2017; 12(9):e0182557. PMC: 5590744. DOI: 10.1371/journal.pone.0182557. View

11.

Saeed Z, Trickett R, Yewlett A, Matthews T . Factors influencing K-wire migration in tension-band wiring of olecranon fractures. J Shoulder Elbow Surg. 2014; 23(8):1181-6. DOI: 10.1016/j.jse.2014.02.018. View

12.

Marot V, Bayle-Iniguez X, Cavaignac E, Bonnevialle N, Mansat P, Murgier J . Results of non-operative treatment of olecranon fracture in over 75-year-olds. Orthop Traumatol Surg Res. 2017; 104(1):79-82. DOI: 10.1016/j.otsr.2017.10.015. View

13.

Murphy D, Greene W, Gilbert J, DAMERON Jr T . Displaced olecranon fractures in adults. Biomechanical analysis of fixation methods. Clin Orthop Relat Res. 1987; (224):210-4. View

14.

Ren Y, Qiao H, Wei Z, Lin W, Fan B, Liu J . Efficacy and safety of tension band wiring versus plate fixation in olecranon fractures: a systematic review and meta-analysis. J Orthop Surg Res. 2016; 11(1):137. PMC: 5109676. DOI: 10.1186/s13018-016-0465-z. View

15.

Altman D . Confidence intervals for the number needed to treat. BMJ. 1998; 317(7168):1309-12. PMC: 1114210. DOI: 10.1136/bmj.317.7168.1309. View

16.

Morrey B . Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instr Course Lect. 1995; 44:175-85. View

17.

Newman S, Mauffrey C, Krikler S . Olecranon fractures. Injury. 2009; 40(6):575-81. DOI: 10.1016/j.injury.2008.12.013. View

18.

Phadnis J, Watts A . Tension band suture fixation for olecranon fractures. Shoulder Elbow. 2017; 9(4):299-303. PMC: 5598818. DOI: 10.1177/1758573216687305. View

19.

Duckworth A, Bugler K, Clement N, Court-Brown C, McQueen M . Nonoperative management of displaced olecranon fractures in low-demand elderly patients. J Bone Joint Surg Am. 2014; 96(1):67-72. DOI: 10.2106/JBJS.L.01137. View

20.

Scolaro J, Schenker M, Yannascoli S, Baldwin K, Mehta S, Ahn J . Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am. 2014; 96(8):674-81. DOI: 10.2106/JBJS.M.00081. View