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Locked Tension Band Wiring: A Modified Technique for Olecranon Fractures—A Multicenter Study Comparing Clinical Outcomes and Complications with Conventional Methods

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Abstract

Purpose

Tension band wiring is the standard treatment for olecranon fractures, but it is associated with high rate of implant-related complication. To reduce this high complication rate, we developed a modified technique, locked tension band wiring (LTBW). The aim of this study was to investigate whether LTBW reduces complication and reoperation rates compared to conventional methods (CTBW).

Methods

We identified 213 olecranon fractures treated with tension band wiring: 183 were treated with CTBW, and 30 were treated with LTBW, and patients in each group were selected using propensity score matching. We evaluated operation time, intraoperative bleeding, complication and reoperation rates, the amount of Kirschner’s wire (K-wire) back-out, and Mayo Elbow Performance Index (MEPI). Complications included nonunion, loss of fracture reduction, implant failure, infection, neurological impairment, heterotopic ossification, and implant irritation. Implant removal included at the patient's request with no symptoms.

Results

We finally investigated 29 patients in both groups. The mean operation time was significantly longer in the LTBW (106.7 ± 17.5 vs. 79.7 ± 21.1 min; p < 0.01). Complication rates were significantly lower in the LTBW than the CTBW group (10.3 vs. 37.9%; p = 0.03). The rate of implant irritation was more frequent in the CTBW, but there was no significant difference (3.4 vs. 20.7%; p = 0.10). Removal rate was significantly lower in the LTBW (41.4 vs. 72.4%; p = 0.03). The mean amount of K-wire backout at last follow-up was significantly less in the LTBW (3.79 ± 0.65 mm vs. 8.97 ± 3.54 mm; p < 0.01). There were no significant differences in mean MEPI at all follow-up periods (77.4 ± 9.0 vs. 71.5 ± 14.0; p = 0.07, 87.4 ± 7.2 vs. 85.2 ± 10.3; p = 0.40, 94.6 ± 5.8 vs. 90.4 ± 9.0; p = 0.06, respectively).

Conclusion

Our modified TBW significantly increased operation time compared to conventional method, but reduced the complication and removal rate and had equivalent functional outcomes in this retrospective study.

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Data availability

Data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank both participating hospitals of the trauma research group associated with the Department of Orthopedic Surgery of Nagoya University for their contribution of data to this study and the members of the trauma research group. Special thanks to Yotaro Yamada, Yuma Saito, Ryutaro Shibata, Yasushi Hiramatsu, Yutaro Ono, Kentaro Komaki, Yui Matsura, Koichiro Makihara, Saki Sakurai, Ken Mizuno, Yusuke Mori, and Reika Kaneko for data collection.

Funding

This study has no funding support.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Registrar, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yutaro Kuwahara

  2. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Yasuhiko Takegami & Shiro Imagama

  3. Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan

    So Mitsuya & Kenichi Yamauchi

  4. Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Katsuhiro Tokutake

Authors
  1. Yutaro Kuwahara
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  2. Yasuhiko Takegami
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  3. So Mitsuya
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  4. Katsuhiro Tokutake
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  5. Kenichi Yamauchi
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  6. Shiro Imagama
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Contributions

YK: data collection and assessment, study design, and writing the paper. YT: manuscript preparation, study and conception design. SM: conception design. KT: manuscript preparation and study design. KY: data collection and assessment, and manuscript preparation. SI: conception design and guarantor.

Corresponding author

Correspondence to Yasuhiko Takegami.

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Kuwahara, Y., Takegami, Y., Mitsuya, S. et al. Locked Tension Band Wiring: A Modified Technique for Olecranon Fractures—A Multicenter Study Comparing Clinical Outcomes and Complications with Conventional Methods. JOIO 57, 2024–2030 (2023). https://doi.org/10.1007/s43465-023-01017-y

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  • DOI: https://doi.org/10.1007/s43465-023-01017-y

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