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Olecranon Fracture Fixation: Is Removal of Hardware Greater After Tension-Band Wiring versus Locked Plating?
Brooks Martino, MD
1, Mason Sellig, MS
2, Joseph Thiel, BS
2, Yousef Soliman, BS
1, Anthony Castro, BA
1, Chris Sun, BA
1; Asif M. Ilyas, MD, MBA
1,2(1)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, (2)Drexel University College of Medicine, Philadelphia, PA
Introduction: Olecranon fractures are common injuries in adults and frequently require operative repair. The two most common surgical options, tension band wiring and plating, differ not only in technique but also potentially in reoperation rates. A retrospective study was performed to better understand the difference in reoperation rates between these two surgical options. The study hypothesis was that the reoperation rate would be similar for both fixation techniques.
Methods: A retrospective review of all isolated olecranon fracture cases performed at a single private academic institution between Jan 1, 2016, and Dec 31, 2020, was conducted. All charts were reviewed to identify fracture type, surgical technique, instance of reoperation, and reason. Patients were excluded if they had associated fractures and injuries of the elbow (e.g., fracture of the radial head or distal humerus).
Results: A total of 169 patients were identified with isolated olecranon fractures that underwent operative fixation with either tension band wiring or locked plating. In total, 74 (44%) underwent tension band wiring and 95 patients (56%) underwent plating. The rate of hardware removal was 30% (n = 22) in tension band wiring and 18% (n = 17) in plating (P value 0.07). The most common reason for hardware removal was pain over the hardware (n = 31); the next most common reason was hardware failure/loss of fixation requiring revision fixation (n = 8). Other demographic factors and fracture characteristics failed to show significant correlations to the rate of reoperation.
Conclusion: The study hypothesis was not upheld. In this series of 169 patients, the hardware removal rate was 30% for tension band wiring cases versus 18% among plating cases. The majority of these patients underwent reoperation due to pain at the surgical site over prominent hardware. This information can be used in selecting a fixation technique and counseling patients on the possibility of reoperation.
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