Outcomes of suture tension band technique for fixation of olecranon fractures: a retrospective case series

Background

Tension band wiring is one of the earliest and most common techniques for the fixation of olecranon fractures with good functional outcomes. However, it is fraught with hardware-related complications, with reported reoperation rates of 33.3%-79.2%. Despite the aim of reducing hardware-related complications, low-profile precontoured plates continue to have hardware removal rates of 15%-56%. Suture tension band fixation is a novel technique for the management of select olecranon fractures with equivalent or superior biomechanical performance to tension band wiring and avoids hardware-related complications associated with tension band wiring and plate fixation. However, outcomes of this fixation technique are not yet well-reported. The goal of this study was to evaluate the clinical and radiographic outcomes of patients who underwent suture tension band fixation of select olecranon fractures.

Methods

This study was a retrospective case series of 25 patients with simple transverse or short oblique olecranon fractures or fractures with minimal comminution that can be converted to a simple fracture pattern who underwent suture tension band fixation. Our primary outcome was the reoperation rate for symptomatic fixation material, failure of fixation, or nonunion. Secondary outcomes were elbow and forearm range of motion, rate of union, as well as patient-reported outcome measures including the patient-rated elbow evaluation, Quick Disabilities of the Arm, Shoulder, and Hand, and the Single Assessment Numeric Evaluation scores at the final follow-up.

Results

The average age of patients in our cohort was 59 ± 19 years, and 64% (n = 14) of patients were female. Our average follow-up time was 14 ± 9 months. None of the patients required reoperation for prominent or irritating suture material, failure of fixation, or nonunion. The patients achieved an average elbow arc of motion of 134° ± 9° and an average forearm arc of 156° ± 12° at the final follow-up. At the time of the final follow-up, patients reported an average patient-rated elbow evaluation of 16.6 ± 8.6, Quick Disabilities of the Arm, Shoulder, and Hand of 9.0 ± 11.2, and Single Assessment Numeric Evaluation score of 93% ± 8%. Complications included one case of postoperative infection, one asymptomatic nonunion, and one fracture through the ulnar tunnel as a result of subsequent trauma.

Conclusion

The suture tension band technique is a viable option for managing simple olecranon fractures or fractures with minimal comminution that can be converted to a simple fracture pattern. This technique yields excellent clinical and radiographic outcomes and avoids hardware-related complications associated with tension band wiring and plate fixation. Larger cohorts and randomized clinical trials are needed to confirm these findings.