Tension Band Wire Fixation Versus Plating for Olecranon Fractures, A Prospective Trial

Background: The aim of this single-center, prospective trial was to compare outcomes of tension-band wire (TBW) versus plate fixation for simple displaced olecranon fractures.

Methods: We performed a prospective trial involving 32 patients over 18 years old who had acute displaced olecranon fractures. Patients were divided to TBW (n = 22) or plate fixation (n = 10) and were evaluated at three months, six months, and one year following surgery. The primary outcome measures were Disabilities of the Arm, Shoulder, and Hand (DASH) score and Oxford Elbow score at one year.

Results: Fracture characteristics and baseline demographic of the two groups were all comparable except for age, which was lower in the Tension Band group (53±18 vs 65±13; p = 0.301). The one-year follow-up rate was 80% (n = 32) and all patients completed the DASH and Oxford Elbow scores. At the three-month follow-up period better rehabilitation was seen in the TBW group, however at the end of the one-year follow-up period, no significant difference was observed in the DASH scores (p = 0.699), Oxford Elbow score (p = 0.760), or range of motion between groups. Complication rate was higher in TBW group, predominantly because of a higher rate of metalwork implant removal in symptomatic patients. No significant differences were seen between the groups in terms of delayed union (0.648), infection (1.000) and unsatisfying range of motion (1.000). Surgery time on average was longer for plate fixation.

Conclusions: Our study showed that there is no significant difference between TBW and plate fixation in the patient-reported outcomes at one year following surgery. Complication rate was higher following TBW fixation predominantly due to a higher rate of metalwork implant removal. Future randomized perspective trials are necessary in order to determine the preferred treatment method.