Comparison of complications, reoperations, and outcomes between tension band wiring and plate fixation in olecranon fractures

Introduction: Olecranon fractures are relatively common upper extremity fractures often treated with tension band wiring and plate fixation. The purpose of this review is to compare the complications, reoperation rates, and clinical and radiographic outcomes of tension band wiring and plate fixation in patients treated surgically for olecranon fractures at our institution. Methods: Retrospective review identified 59 patients (27 men and 32 women) treated operatively for olecranon fractures between 2006 and 2016 at our level 1 trauma center. The average age was 47 years (range: 17 to 81 years). Medical records were reviewed for complications, reoperation rates, and other perioperative variables. The average follows up time was 12 months. All patients were assessed clinically and radiographically at their latest follow up. Results: Of the 59 patients with an olecranon fracture, 23 underwent treatment with tension band wiring and 36 underwent plate fixation. The overall complication rate was 55.9%. The most common overall complication was symptomatic implants seen in 44.1% of patients. Complications were greater in the tension band group (65.2%) compared to the plate fixation group (50%). The overall rate of implant removal for both fixation groups was 39.0%, performed at an average time of 11.6 months. This was seen in 43.5% of the tension band group and 36.1% in the plate fixation group. Implant removal was most commonly performed for symptomatic hardware. The mean elbow extension deficit was 7 degrees for both groups. Plate fixation required significantly longer operating times (110 verse 81 minutes). Radiographic arthrosis was seen in nine patients (15.3%) and heterotrophic ossification was seen in seven (11.9%). Conclusion: Though both tension band wiring and plate fixation are reliable fixation methods that provide a consistent union of olecranon fractures, our series demonstrates high rates of complications and reoperations for both methods.