Strategies in Trauma and Limb Reconstruction

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VOLUME 15 , ISSUE 3 ( September-December, 2020 ) > List of Articles

Original Article

Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation—A Randomised Controlled Study

Siddhartha Sinha, Rajiv Maharjan, Guru P Khanal, Bishnu Pokharel, Nikhil Drolia, Sumit Gupta, Rajesh K Kanojia, Pashupati Chaudhary

Citation Information : Sinha S, Maharjan R, Khanal GP, Pokharel B, Drolia N, Gupta S, Kanojia RK, Chaudhary P. Comparison of Functional and Radiological Outcomes of Olecranon Fractures Treated with Tension Band Wiring with Kirschner Wires to Transcortical Screw Fixation—A Randomised Controlled Study. 2020; 15 (3):131-137.

DOI: 10.5005/jp-journals-10080-1510

License: CC BY-NC-SA 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: To compare the clinical and radiological outcomes of fixation of olecranon fractures by a transcortical screw with conventional tension band wiring (TBW) using a Kirschner wire (K-wire). Material and methods: This is a non-blinded randomised controlled trial comprising two groups (n = 30 each) with Mayo type A olecranon fractures fixed with either TBW or transcortical cancellous screws (CCS). Outcomes included the Mayo elbow performance index (MEPI), time to union, range of motion (ROM), and rates of complication among these two groups. Results: Most of the patients showed excellent scoring as per MEPI in both the groups at 6 weeks (90% in TBW group and 76.7% in CCS group) and were not significant (p = 0.719). Signs of the radiological union were noted in 80% of the cases at 6 weeks and complete at 6 months. Hardware-related complications (8.3% symptomatic hardware and 6.7% implant back-out), infection, and mean ROM were similar between the two groups (elbow flexion was 142.33 ± 24.67° in TBW group and 143.1 ± 10.19° in transcortical screw group, p = 0.246) at the end of the study. Conclusion: There were no statistically significant differences in the clinical–radiological outcomes and complications fixing the non-comminuted olecranon fractures with either transcortical screw or TBW. Clinical significance: Transcortical screw fixation is an acceptable alternative to TBW for non-comminuted olecranon fractures in terms of union and functional outcome.


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  1. Beingessner DM, Pollock JW, King GJW. Elbow fractures and dislocations. In: Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta III P, McKee MD, editors. Rockwood and Green's: fractures in adults. 8th edn. North America: Wolters Kluwer; 2015, pp. 1180–1227.
  2. Perez E. Fractures of the shoulder, arm, and forearm. In: Canale ST, Beaty JH, editors. Campbell's operative orthopaedics. 12th ed. Philadelphia, PA: Mosby Elsevier; 2012.
  3. Chalidis BE, Sachinis NC, Samoladas EP, et al. Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res 2008;3:9. DOI: 10.1186/1749-799X-3-9.
  4. Jones TB, Karenz AR, Weinhold PS, et al. Transcortical screw fixation of the olecranon shows equivalent strength and improved stability compared with tension band fixation. J Orthop Trauma 2014;28(3):137–142. DOI: 10.1097/BOT.0b013e31829a25d2.
  5. Lu Q, Tang G, Zhao X, et al. Tension band wiring through double-cannulated screws as a new internal fixation method for treatment of olecranon fractures: a randomized comparative study. Acta Orthop Traumatol Turc 2015;49(6):654–660. DOI: 10.3944/AOTT.2015.14.0330.
  6. Nowak T, Mueller L, Burkhart K, et al. Dynamic biomechanical analysis of different olecranon fracture fixation devices–tension band wiring versus two intramedullary nail systems: an in-vitro cadaveric study. Clin Biomech 2007;22(6):658–664. DOI: 10.1016/j.clinbiomech.2007.02.003.
  7. Parker J, Conroy J, Campbell D. Anterior interosseus nerve injury following tension band wiring of the olecranon. Injury 2005;36(10):1252–1253. DOI: 10.1016/j.injury.2004.12.028.
  8. Hahn A, O’Hara NN, Koh K, et al. Is intramedullary screw fixation biomechanically superior to locking plate fixation and/or tension band wiring in transverse olecranon fractures? A cadaveric biomechanical comparison study. Injury 2020;51(4):850–855. DOI: 10.1016/j.injury.2020.02.059.
  9. Hutchinson DT, Horwitz DS, Ha G, et al. Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am 2003;85(5):831–837. DOI: 10.2106/00004623-200305000-00010.
  10. Panchal HC, Bhabhor PK. 6.5 mm cancellous screw with washer vs tension band wiring for fractures of the olecranon. Int J Orthop 2019;5(4):971–975. DOI: 10.22271/ortho.2019.v5.i4q.1803.
  11. Raju S, Gaddagi RA. Cancellous screw with tension band wiring for fractures of the olecranon. J Clin Diagn Res 2013;7(2):339–341. DOI: 10.7860/JCDR/2013/4450.2762.
  12. Woods BI, Rosario BL, Siska PA, et al. Determining the efficacy of screw and washer fixation as a method for securing olecranon osteotomies used in the surgical management of intraarticular distal humerus fractures. J Orthop Trauma 2015;29(1):44–49. DOI: 10.1097/BOT.0000000000000131.
  13. Haddad B, Khan W, Zaghloul A, et al. Fixation of olecranon fractures and osteotomies using compression screws: a simple solution to a common problem. A study of cases. Ortop Traumatol Rehabil 2013;15(4):341–346. DOI: 10.5604/15093492.1073833.
  14. Brink P, Windolf M, De Boer P, et al. Tension band wiring of the olecranon: is it really a dynamic principle of osteosynthesis? Injury 2013;44(4):518–522. DOI: 10.1016/j.injury.2012.08.052.
  15. Wagener ML, Driesprong M, Heesterbeek PJ, et al. Biomechanical evaluation of three different fixation methods of the Chevron osteotomy of the olecranon: an analysis with Roentgen Stereophotogrammatic Analysis. Clin Biomech 2013;28(7):752–756. DOI: 10.1016/j.clinbiomech.2013.06.011.
  16. Uhlmann M, Barg A, Valderrabano V, et al. Treatment of isolated fractures of the olecranon: percutaneous double-screw fixation versus conventional tension band wiring. Unfallchirurg 2014;117(7):614–623. DOI: 10.1007/s00113-013-2389-y.
  17. Wolfgang G, Burke F, Bush D, et al. Surgical treatment of displaced olecranon fractures by tension band wiring technique. Clin Orthop Relat Res 1987;224:192–204. DOI: 10.1097/00003086-198711000-00026.
  18. Wilson J, Bajwa A, Kamath V, et al. Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br 2011;93(2):245–250. DOI: 10.1302/0301-620X.93B2.24613.
  19. Bosman WMP, Emmink BL, Bhashyam AR, et al. Intramedullary screw fixation for simple displaced olecranon fractures. Eur J Trauma Emerg Surg 2020;46:83–89. DOI: 10.1007/s00068-019-01114-4.
  20. Wagener ML, Dezillie M, Hoendervangers Y, et al. Clinical results of the re-fixation of a Chevron olecranon osteotomy using an intramedullary cancellous screw and suture tension band. Strategies Trauma Limb Reconstr 2015;10(1):1–4. DOI: 10.1007/s11751-015-0211-9.
  21. Amini MH, Azar FM, Wilson BR, et al. Comparison of outcomes and costs of tension-band and locking-plate osteosynthesis in transverse olecranon fractures: a matched-cohort study. Am J Orthop (Belle Mead NJ) 2015;44(7):E211–E215.
  22. Koziarz A, Woolnough T, Oitment C, et al. Surgical management for olecranon fractures in adults: a systematic review and meta-analysis. Orthopedics 2019;42(2):75–82. DOI: 10.3928/01477447-20190221-03.
  23. Romero JM, Miran A, Jensen CH. Complications and re-operation rate after tension-band wiring of olecranon fractures. J Orthop Sci 2000;5(4):318–320. DOI: 10.1007/s007760070036.
  24. Schliemann B, Raschke MJ, Groene P, et al. Comparison of tension band wiring and precontoured locking compression plate fixation in Mayo type IIA olecranon fractures. Acta Orthop Belg 2014;80(1):106-111.
  25. Macko D, Szabo RM. Complications of tension-band wiring of olecranon fractures. J Bone Joint Surg Am 1985;67(9):1396-1401. DOI: 10.2106/00004623-198567090-00015.
  26. Villanueva P, Osorio F, Commessatti M, et al. Tension-band wiring for olecranon fractures: analysis of risk factors for failure. J Shoulder Elbow Surg 2006;15(3):351–356. DOI: 10.1016/j.jse.2005.08.002.
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