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Use of an Iso-Elastic Tension Band for the Treatment of Olecranon Fractures
Rebecca A. Rajfer, BS; Jonathan R. Danoff, MD; Ioannis C. Zouzis, MD; Melvin P. Rosenwasser, MD
Department of Orthopaedic Surgery, Columbia University, New York, NY

Purpose: This study was designed to evaluate the functional outcome of iso-elastic tension band wiring for olecranon fractures.  The hypothesis was that the iso-elastic high molecular weight polyethylene cerclage cable has a reduced side effect profile compared to stainless steel wire and can be utilized for tension band cabling of displaced olecranon fractures with minimal or no comminution.

Methods: Seven patients treated by the senior investigator with open reduction and internal fixation for displaced olecranon fractures with minimal or no comminution were prospectively followed to union for a time interval of 8 months to 3.4 years.  A chart review was conducted and patients underwent a physical examination inclusive of elbow range of motion measurements and grip strengths at each follow-up visit.  Bony union was confirmed by radiographic examination.  Functional assessment was completed utilizing the Disabilities of the Arm, Hand, and Shoulder (DASH) questionnaire, the Broberg and Morrey elbow score, and visual analogue scales (VAS) for pain and satisfaction.  Physical exam measurements of the injured side were compared to the contralateral non-injured elbow and average scores for all functional outcomes were calculated.

Results: The mean age was 63 years old (range 19-84).  Fracture reduction was maintained in all elbows through union.  Physical exam measurements indicated nominal side-to-side differences in motion (96% return of flexion-extension arc, 99% return of pronation-supination arc) and strength (102% return of grip strength).  The mean Broberg and Morrey elbow score was “good” (93/100).  The mean DASH score was 7.0 (S.D. 12.4).  Patients had low mean VAS pain ratings of 0.8/10 (range 0-3) and high mean VAS satisfaction ratings of 9.9/10 (range 9.5-10).  Two patients reported being “bothered” by hardware at latest follow-up, but not enough to request removal.  There were no infections.  One patient required hardware removal for a sterile synovial fistula and a second patient had a single migrated Kirschner wire removed in the office.

Conclusions: As demonstrated by near-normal return of range of motion and strength, minimal pain, high satisfaction ratings, and excellent functional outcomes, displaced olecranon fractures with minimal or no comminution can be successfully treated with the iso-elastic tension band procedure.  The ability to perform reproducible tensioning with this cable over the standard twisted wire technique may provide an advantage.  This technique may be able to lower the reported high incidence (up to 80%) of secondary surgery to remove painful hardware.  


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