COMPLICATIONS OF TENSION BAND WIRE FIXATION OF OLECRANON FRACTURES

Abstract

Despite the literature reporting a high complication rate tension band wiring remains a common technique for the fixation of olecranon fractures.

In our unit 44 patients who underwent tension band wiring of olecranon fractures between May 1998 and May 2002 were reviewed specifically with regards factors that might be responsible for a poor outcome. The patient’s age at the time of injury, mode of injury and fracture configuration were recorded. In addition the adequacy of reduction was assessed and the position of the k-wires (parallel/non-parrallel, anterior cortex fixing/intramedullary) length of wire beyond the fracture line and number of circlage wire twists noted.

All patients had a minimum follow-up of 12 months. 22 patients (50%) had complications following the index procedure of which 8 had wire back out, 7 had pain and discomfort requiring removal of the metalwork and 4 had wound infections. Fixation of the radius occurred in 1 patient and 2 patients developed a non-union. In all further surgery was needed in 18 patients (41%).

No common features were identified in patients developing complications and in particular no statistical difference was found when k-wire position (P=0.35) length of k-wire beyond the fracture line (P=0.34) and number of circlage wire twists (P=0.33) were analysed.

Using Kaplan-Meier analysis the patients who required wire removal were likely to undergo their surgery within 6 months of fracture fixation.

The high complication rate begs the question: Is this an appropriate modern method of fracture fixation?