Metal Tension-Band Wires vs Tension-Band Sutures in the Fixation of Olecranon Fractures: A Systematic Review

Background: Tension-Band Wiring (TBW) is the treatment of choice for displaced, non-comminuted olecranon fractures. Due to the high complication rate involved with TBW, particularly the need for re-operative hardware removal, an alternate method using a high-strength, non-metallic Tension-Band Suture (TBS) construct has been precipitated. There is currently no literature comparing and evaluating these 2 particular techniques, therefore, this systematic review aims to address this. Methods: 6 databases were searched (MEDLINE, Embase, Web of Science, Cochrane Library, The CRD and Clinicaltrials.gov). Titles, abstracts and full articles were then systematically screened against the eligibility criteria. The primary outcomes studied were reported postoperative functional outcomes, and complication rates. Results: From 2538 identified abstracts, 5 studies met our eligibility criteria. Only one study compared TBW with TBS and concluded that in paediatric patients, there is a lack of benefit from TBS due to a similar rate of reoperation for hardware removal. 4 studies solely analysed TBW. In TBW, the rate of reoperation reached as high as 76.5% with the need for hardware removal being the most common indication. Conclusion: This review was required to highlight the alarming paucity of studies analysing TBS fixation in the treatment of non-comminuted olecranon fractures. Based on the included studies, it is difficult to conclude an advantage for either TBW or TBS due to the lack of standardised measuring of functional outcomes and comparative studies. There is potential for a reduced rate of reoperation in TBS, however, there is a great need for more robust studies analysing this technique.