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VOLUME 9 , ISSUE 2 ( August, 2014 ) > List of Articles


Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture

Karuppaiah Karthik, Ramon Tahmassebi, Adel Tavakkolizadeh, Jonathan Compson

Keywords : Olecranon fracture, Tension band wiring, Heterotopic ossification, Restricted forearm rotation, Proximal radio-ulnar synostosis

Citation Information : Karthik K, Tahmassebi R, Tavakkolizadeh A, Compson J. Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture. 2014; 9 (2):121-125.

DOI: 10.1007/s11751-014-0197-8

License: CC BY-NC-SA 4.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2014; The Author(s).


A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30° on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6 months, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis

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  1. Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD (2008) Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res 22(3):9
  2. Van der Linden SC, van Kampen A, Jaarsma RL (2012) K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures. J Shoulder Elbow Surg 21(3):405-411
  3. Romero J, Miran A, Jensen CH (2000) Complications and reoperation rate after tension-band wiring of olecranon fractures. J Orthop Sci 5:318-320
  4. Macko D, Szabo RM (1985) Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 67:1396-1401
  5. Candal-Couto JJ, Williams JR, Sanderson PL (2005) Impaired forearm rotation after tension-band-wiring fixation of olecranon fractures. J Orthop Trauma 19:480-482
  6. Matthews F, Trentz O, Jacob AL, Kikinis R, Jupiter JB, Messmer P (2007) Protrusion of hardware impairs forearm rotation after olecranon fixation. A report of two cases. J Bone Joint Surg Am 89(3):638-642
  7. Velkes S, Tytiun Y, Salai M (2005) Proximal radio-ulnar synostosis complicating tension band wiring of the fractured olecranon. Injury 36(10):1254-1256
  8. De Carli P, Gallucci GL, Donndorff AG, Boretto JG, Alfie VA (2009) Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: a case report. J Shoulder Elbow Surg 18(3):e40-e44
  9. Lee SH, Han SB, Jeong WK, Park JH, Park SY, Patil S (2010) Ulnar artery pseudoaneurysm after tension band wiring of an olecranon fracture resulting in Volkmann's ischemic contracture: a case report. J Shoulder Elbow Surg 19(2):e6-e8
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