///

Suture tension-band fixation of olecranon fracture using Arthrex Fibretape sutures

    Overview

    Learn the Suture tension-band fixation of olecranon fracture using Arthrex Fibretape sutures surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Suture tension-band fixation of olecranon fracture using Arthrex Fibretape sutures surgical procedure.
    Olecranon fractures comprise around 10% of all fractures around the elbow. They have a bimodal distribution and usually occur as high energy injuries in the young, and low energy falls in the elderly.
    These can occur as a direct blow, resulting in comminuted fractures, or indirectly, as a fall onto an outstretched hand, resulting in transverse or oblique fractures.
    The position of the elbow can influence the pattern of injury. Radial head and coronoid fractures have been shown to occur in laboratory testing at flexion of less than 80 degrees, olecranon fractures at 90 degrees of flexion and distal humeral fractures at greater than 110 degrees (Amis AA, Miller JH. The mechanism of elbow fractures: an investigation using impact tests in vitro. Injury 1995;26:163–8).
    Anatomically it is worth remembering that the olecranon, with the coronoid process, form the greater sigmoid notch and form the ulno-humeral articulation that acts as a primary stabilisers of the elbow (along with the medial and lateral collateral ligament). The olecranon receives the insertion of the triceps, as well as the anconeus on the lateral side.
    For displaced fractures of the olecranon, surgical fixation is recommended unless the patient is functionally of low demand or medically at high risk undergoing anaesthetic. The method of fixation is essentially determined by the fracture pattern. My preference is in most cases either for olecranon plating or tension band fixation. Tension band fixation is the commonest method of internal fixation used for non-comminuted olecranon fractures. The principles of tension band fixation involve converting the tension force on the dorsal aspect of the fracture into a dynamic compressive force at the articular surface. However, there are caveats if using the tension band principle as to when it may not be appropriate for fixation as follows:
    1 – Comminution. If there is comminution, there is not enough inherent stability and the fixation is at risk of biomechanical failure as the tension forces are unable to be transferred into a compressive force.
    2 – Obliquity of the fracture. The more oblique the fracture, the more the acting forces deviate from the line of action. This introduces a flexion moment and again, is theoretically less robust.
    3 – Fractures distal to the centre of rotation to the elbow joint. Fractures that occur distal to the centre of rotation, again introduce a flexion moment to the fracture and can affect stability, and therefore risk failure.
    4 – Associated fractures. Coronoid fractures, radial head fractures and Monteggia type fractures can increase instability in the elbow that a tension band fixation is not designed to neutralise.
    If all these factors are satisfied, tension band fixation is a good option. If all the criteria are not satisfied, it does not exclude tension band fixation as a fixation method. It requires, like all surgery, weighing up the pros and cons of the fixation method, and tailored according to the patient.
    Classically, tension band fixation has been performed using Kirschner wires and stainless steel wire secured in a figure of eight configuration. Concerns regarding metalwork prominence and irritation, and wound breakdown, have led to a change by myself towards suture tension band fixation using Fibrewire/Fibretape (Arthrex). The original technique was first described by Professor Watts et al.
    Phadnis J, Watts AC. Tension band suture fixation for olecranon fractures. Shoulder Elbow. 2017 Oct;9(4):299-303. doi: 10.1177/1758573216687305. Epub 2017 Jan 18.
    Metalwork removal rates have been quoted in the region of 50%.
    If these criteria are not satisfied, I opt for pre-contoured Synthes anatomic locking plates. The design of the plate allows more screw options particularly with regard to hold in the proximal fragment, which can be small and multi-fragmentary in some cases. I believe that these plates also offer superior fixation as a result of their fixed-angle construct. This is especially the case if there is concern regarding bone quality in terms of osteoporosis and osteopaenia.
    Readers will also find of use my other olecranon fracture fixation technique on OrthOracle Internal Fixation of Olecranon fracture using Synthes LCP Olecranon plate

    Indications

    INDICATIONS
    Surgical management is reserved for displaced and unstable fractures of the olecranon. The aim is to restore the extensor mechanism to optimise extension strength and function.
    SYMPTOMS & EXAMINATION
    Patients usually present after sustaining a direct blow to the elbow or due to a fall onto an outstretched hand.
    The patient may be unable to extend their elbow.
    It is important to assess the soft tissues and carefully examine the skin to exclude an open fracture.
    It is common to find significant bruising and swelling and it may be possible to palpate the fracture due to the subcutaneous nature of the olecranon. There can be associated soft tissue contusions and abrasions. There may be significant displacement and deformity and it is important to correct this rapidly to take the tension off the soft tissue and limit secondary damage of the soft tissue envelope.
    A neurovascular assessment is important, with particular reference to the ulnar nerve, which can be compromised.
    In high energy injuries, although uncommon, it is important to exclude a compartment syndrome.
    IMAGING
    Anteroposterior and lateral radiographs of the elbow should be obtained.
    Although olecranon fractures are usually isolated injuries, it is important to look for and exclude associated injuries including coronoid fractures, radial head fractures and Monteggia fracture dislocations. These associated injuries can affect the stability of the elbow.
    If the fracture pattern is more complex, a CT scan with coronal and sagittal reconstructons is helpful for surgical planning.
    Classifications
    Numerous classification systems have been described and are largely based on the level of displacement, comminution and stability of the elbow, although none have gained widespread acceptance.
    Colton Classification
    • Type I: Undisplaced and stable (does not displace with elbow flexion)
    • Type II:
    A – avulsion
    B – oblique/transverse
    C – comminuted
    D – fracture dislocation
    (Colton CL. Fractures of the olecranon in adults: classification and management. Injury 1973;5(2):121–9)
    Mayo Classification
    Type 1 – Undisplaced fracture, simple or comminuted (12%)
    Type 2 – Displaced fracture, simple or comminuted (82%)
    Type 3 – Unstable (6%)
    (Morrey BF, JBJS 77A: 718-21, 1995)
    Other classifications include Schatzker and AO.
    Although no one classification is widely used, it is useful for research and assessing outcomes according to severity of the fracture. In terms of everyday management, the factors that will determine the method of management is down to level of displacement, the level of comminution and whether the elbow joint is subluxed as a result of the fracture.
    ALTERNATIVE OPERATIVE TREATMENT
    Metal tension band fixation
    Tension band wire fixation is the commonest method of internal fixation used for non-comminuted olecranon fractures. The principles of tension band wiring involve converting the tension force on the dorsal aspect of the fracture into a dynamic compressive force at the articular surface.
    The exclusion criteria for this technique have been described in the overview. Concerns regarding hardware prominence have led to techniques using suture material with good results.
    Plate fixation
    In the literature, types of plates have been used including one-third tubular, 3.5 mm contoured limited contact dynamic compression, 3.5 mm reconstruction, hook plates as well as pre-contoured anatomic locking plates. There is currently insufficient evidence to suggest that any type of plate fixation is superior to other forms of plate fixation.
    In both cases, there is concern regarding hardware prominence due to the subcutaneous nature of the ulna. Metalwork may need to be removed once the bone has united if it is clinically symptomatic.
    Intramedullary screws and nailing systems have been described in the literature, although is less common. Published results are good and comparable to alternative fixation methods.
    Fragment excision and triceps advancement
    This method is usually reserved for elderly patients with osteoporotic bone, extensive comminution
    or a fragment too small for internal fixation. The triceps tendon is sutured to the anterior edge of the ulna to create a smooth sling for articulation.
    Advantages of the technique include avoiding non-union and post-traumatic arthritis. Fragment excision can only be performed if the coronoid, medial collateral ligament, interosseous membrane and distal radio-ulnar joint are intact to prevent instability.
    McKeever and Buck suggested that up to 80% of the trochlear notch could be excised without appreciably compromising elbow stability. Inhofe and Howard showed good or excellent outcomes in 11 of 12 cases treated with excision of up to 70% of the trochlear notch.
    However, An et al. showed a reduction in elbow stability when over 50% of the trochlear notch was excised.
    It is accepted that a reduction in triceps strength occurs.

    NON-OPERATIVE MANAGEMENT
    Undisplaced and stable olecranon fractures can be treated non-operatively. Undisplaced fractures are generally defined as up to 2mm of displacement, although clinical correlation and assessment of the patient is required before a treatment plan can be recommended.
    Patients can be immobilised in a backslab in 45–90 degrees of flexion for 2-3 weeks to allow the swelling and soft tissues to settle down before commencing physiotherapy.
    However, in elderly patients of low functional demand, good functional outcomes can be achieved despite significant displacement. In a series of 13 patients treated non-operatively of mean age 81.8 years with >5 mm displacement, Veras Del Monte et al. found only one patient had a poor functional outcome.
    CONTRAINDICATIONS
    Patients of low functional demand or medically unfit would be relative contra-indications. As part of informed consent, a discussion of outcomes of conservative and operative methods is essential for treatment planning.

    Setup

    The procedure is performed under general anaesthetic and can be supplemented with a nerve block performed by the anaesthetist. It is usually necessary to supplement this with local anaesthetic and adrenaline infiltrated to the operative field to optimise pain relief and to optimise the field of view.
    The patient is placed in a lateral decubitus position with the affected arm uppermost. The position of the shoulder is checked to ensure it is in an appropriate and comfortable position. The arm is placed in a short ulnar gutter support. Care is taken to ensure that chest wall is well protected from any clamps and metal equipment using gel pads and padding. The elbow can be manipulated during the procedure and can cause pressure areas if not appropriately protected. A surgical prescrub prior to routine skin preparation may be performed.
    A high arm tourniquet is applied and secured to maintain a bloodless field during the procedure. The skin is prepared using Chlorohexidine solution starting at the hand, then onto the whole of the upper limb, up to and including the shoulder. Standard adhesive drapes are used. During this process, the upper limb is elevated and once complete, the tourniquet can be inflated.
    Intermittent calf compression Flotron devices are used during surgery to reduce the risk of thromboembolic disease unless there are any contraindications. Intravenous antibiotics are administered by the anaesthetist prior to inflation of the tourniquet.

    Operation – 1

    Lateral radiograph of left elbow.
    This 90 year old, right hand dominant, retired man sustained the above injury after a fall onto an outstretched hand.
    He is an active gentleman, enjoys walking and is independent and drives.
    After removal of the backslab, the soft tissues appeared satisfactory, although the skin was a little thin.
    The lateral radiograph shows a displaced, comminuted olecranon fracture.
    Fragment A has been displaced proximally by the pull of the triceps brachii muscle.
    On closer inspection, there is some comminution, with depression of the articular fragment (B). However, there is no dorsal subluxation of the ulno-humeral articulation.

    AP radiograph of the left elbow.
    These radiographs confirm that there is no clear radial head fracture (R).
    It also shows that the the elbow articulation is preserved and congruent and that the ulna (U) is aligned.
    The fracture itself is not easily seen as it lies behind the distal humerus (H).

    The patient is set up in a lateral decubitus position with the body stabilised.
    The alignment of the spine is perpendicular to the table but is set close to the edge of the table as is practicable. This is to allow clearance of the table as well as for access to fluoroscopy if indicated.
    A short ulna gutter is used to support the arm. Care is taken to ensure the arm is set up in a stable position and that there is enough clearance to flex and extend the elbow.
    This is usually with the humerus in a position parallel to the floor and level with the shoulder.
    The height of the table is set to ensure a comfortable operating position.
    A high arm tourniquet is applied over a layer of wool to ensure that the operative field of view is clear and the sterile field is maximised. If there is any concern regarding the adequacy of the operative field, a sterile tourniquet may be applied.

    The whole arm is prepped and U drapes are applied and forearm is covered in a stockinette.The drapes are applied at the level of the tourniquet to maximise the sterile field.
    The forearm is covered in a stockinette and wrapped with four inch crepe to isolate the hand. This also keeps the hand clear of any blood.

    An isolation drape is applied which helps to secure the drapes in position and minimise the risk of wound contamination with skin squames.

    The key landmarks to identify and mark are the medial (M) and lateral (L) epicondyle, the ulnar nerve (U) is palpated and marked to ensure that it is protected. The outline of the olecranon (O) is also palpated and marked.The radial and ulnar aspect of the upper arm is marked as an aide for orientation during the operation.


    A longitudinal posterior midline incision is made, centred over the fracture site. The incision starts at the tip of the olecranon (O) and extends distally, curving radially to avoid aligning the incision over a “weight-bearing” surface.The incision is made using a 15 surgical blade through skin and subcutaneous fat down to the level of the muscle fascia.
    Care is taken to ensure that the incision is aligned with the dorsal surface of the ulna distally.

    The soft tissues are retracted using a West retractor to aid exposure.This must be placed deeply, well beneath the skin edges.

    The fracture haematoma is easily identified due to the subcutaneous nature of the olecranon.

    The haematoma is curetted and washed out to visualise the fracture anatomy.

    The fracture surface is exposed.
    The fracture surface on the ulna shaft (A) is identified and cleared of haematoma.

    Any infolding periosteum or soft tissues are elevated from the fracture edges on the ulnar shaft fragment.The fracture edges are defined using a knife.
    Any in-folded periosteum or soft tissue is either removed or reflected back so that it does not compromise reduction of the fracture.

    The appropriate plane at the level of the muscle fascia is identified and the medial and lateral cutaneous flaps are raised.Anconeus (A) is identified radially and flexor carpi ulnaris (B) ulnarly.
    The flaps are raised to allow adequate exposure of the olecranon and proximal ulna shaft (C).
    5cm of bony exposure of the ulna shaft distal to the fracture site is required for tension band fixation.
    Anconeus lies on the posterolateral aspect of the elbow. It originates from the posterior surface of the lateral epicondyle and inserts onto the posterior superior surface of the ulna.
    It is supplied by branches of the radial nerve and assists triceps brachii in extension as well as abduction of the ulna and stabilisation of the elbow joint.
    Flexor carpi ulnaris (FCU) lies on the medial aspect of the forearm. It consists of two heads, which originate from the medial epicondyle of the distal humerus and proximal ulna. The ulnar nerve and artery pass under a tendinous arch formed between the two heads.
    It inserts onto the pisiform, hamate and fifth metacarpal base and acts as a flexor and adductor of the wrist.
    It is innervated by the ulnar nerve.

    Any residual fracture haematoma is washed out so as to better characterise and define the fracture edges.
    The fracture can be distracted or retracted using either a bone hook or Langenbeck retractor.

    The haematoma is depicted by the forceps in this image.
    Haematoma within the elbow joint is debrided and thoroughly washed out.


    The fracture pattern and characteristics can then be better defined after removal of haematoma.

    In this image, the proximal fragment of the olecranon (A) has been retracted using a bone hook.
    The impacted articular fragment seen on the lateral radiograph is marked by the forceps.
    From the image, you can see that the articular surface has been impacted and is no longer congruent with the trochlear (B).

    The fracture edges on the proximal fragment are defined by sharp dissection.By using sharp dissection starting on the bone from the fracture edge, any injury to the ulnar nerve on the ulnar aspect of the olecranon can be avoided.
    If there is any concern regarding the ulnar nerve, it is best to extend the incision proximally so that you are outside the zone of injury. The ulnar nerve can be located at the medial edge of the triceps muscle and traced distal down to the cubital tunnel and deep to the flexor carpi ulnaris fascia.

    The bone hook is useful for manipulating the proximal fragment to access difficult to view areas.
    By tilting the proximal fragment dorsally(as shown) the articular surface can be inspected from here.

    Note, it is important to remove any loose fracture fragments to minimise the risk of “third body” wear.
    It also helps in fracture reduction by accounting for any defects and minimises the risk of over-reduction.

    The elbow joint can be clear of any residial haematoma using a gauze swab. This allows the articular cartilage to be cleared and inspected.

    Once haematoma is removed and the fracture margins defined and the elbow cartilage is inspected for any chondral damage.

    The flexor carpi ulnaris (A) and anconeus (B) muscle fascia is incised at the dorsal ridge of the proximal ulna (C) to expose the ulnar shaft.The respective muscle bellies are dissected of the bone using a knife or periosteal elevator to expose the proximal ulna.
    The FCU muscle belly is elevated medially from the dorsal ridge (C) and the anconeus muscle belly is elevated laterally.

    A Macdonald dissector or mini-Hohmanns retractor is used to retract the FCU muscle belly (A) away from the bone.Note the MacDonald dissector should hook around the anterior cortex of the ulna shaft.

    A transverse drill hole is made through the subcutaneous border of the Ulna, from medial to lateral using a 2.5mm drill.The drill hole is usually made around 4-5cm distal to the fracture site.
    It is usually 1cm anterior to the dorsal surface of the ulna shaft.
    It is important to get the drill hole perpendicular to the dorsal surface to make retrieval of wires easier.
    The universal drill sleeve will aid in controlling direction and ensuring the soft tissues are out of the way.
    If the soft tissues do get in the way, extension of the incision will reduce the soft tissue tension and allow greater access.

    Operation – 2

    A retractor is applied over the radial side of the ulna shaft to visualise the exit hole of the drill bit.It is important to see the drill exit at around the same level and that the drill hole remains transverse.
    The retractor applied over the radial side of the ulna retracts the anconeus muscle belly (B) to optimise exposure.

    A unicortical pilot hole is drilled around 1-2 cm distal to the fracture in a postero-anterior direction.This is to aid with the application of a pointed reduction clamp.
    Due to the orientation of the points on the clamp, the clamp often skids off if this step is missed.

    A large pointed reduction clamp is applied to reduce the fracture.The forceps can be used to guide the fracture fragments and fine tune the reduction.
    Some pre-planning of the the position of the reduction clamps on the proximal fragment allows space for application of the Kirschner wire. This can be positioned radial or ulnar of midline.

    A smaller pointed reduction clamp manipulating the proximal fragment can help adjust for any rotational malalignment.
    In fresh fractures, assessing the fracture pattern and reducing the fracture edges is essential for getting an anatomical reduction.

    A 1.6mm Kirschner wire is inserted longitudinally and engaged carefully into the anterior cortex, following fracture reduction.This augments the reduction so that it is more robust during manipulation.
    It is useful to palpate for the alignment of the ulna shaft to guide the K-wires line of insertion along the longitudinal axis of the bone.
    By also siting the entry point more dorsally, there is a better chance of engaging the wire in the anterior cortex (and avoiding the elbow joint).
    If this angle is too shallow, however the K-wire can sometimes skid along in the intra-medullary canal.

    In this case, good fracture reduction has been achieved.

    As there was some medial wall comminution (with soft tissue attachment), a second K-wire was applied to maintain reduction of this fragment before definitive fixation commenced.

    A Fibretape suture is loaded onto a curved Mayo needle and passed through the transverse drill hole from lateral to medial.The Fibretape is passed through the drill hole from A to B.
    Fibretape is a high strength braided polyblend suture and is made up of a ultra high molecular weight polyethylene (UHMWPE) and polyester. It is 2mm in diameter and tapers to a number 2 Fibrewire at the ends. It comes in 76cm and 137cm sizes.
    For olecranon fixations, the 76cm length should suffice.

    The 2 Fibretape sutures are sutured in the following sequence from A to I. This will be shown in more detail in the subsequent slides.
    Suture 1
    The Fibretape is passed through:
    1 – Transverse hole from lateral to medial (A to B)
    2 – Medial triceps insertion (C to D)
    3 – Transverse hole from medial to lateral (E to F)
    4 – Lateral triceps insertion (G to H)
    5 – Suture ends are tied on lateral aspect of proximal ulna (I)
    Suture 2
    1 – Transverse hole from lateral to medial (A to B)
    2 – Lateral triceps insertion (C to D)
    3 – Transverse hole from medial to lateral (E to F)
    4 – Medial triceps insertion (G to H)
    5 – Suture ends are tied on lateral aspect of proximal ulna (I)

    The Fibretape is passed through the triceps tendon on the ulnar side.The Fibretape runs from the medial side of the transverse drill hole (B) up to the medial insertion of the triceps tendon (C).
    A bite of the medial triceps insertion is taken and retrieved (D).

    The suture is retrieved.

    The Fibretape is passed back through the drill hole from medial to lateral.The Fibretape then runs from point D back to the medial side of the transverse drill hole (E).

    The suture is passed back through the transverse drill hole and retrieved from the lateral side.The Fibretape runs from E to F.
    To avoid passing the needle through the suture material in the bony tunnel, it is helpful to keep the suture in the tunnel under tension.

    A similar bite is taken from the lateral aspect of the triceps insertion using the Fibretape.The Fibretape runs from F to G to H.
    The limbs of the Fibretape sutures are tensioned and the two ends are tagged with an artery clip at point I.

    A second Fibretape suture is passed through the same drill hole from lateral to medial.The Fibretape runs from A to B.

    The needle is again retrieved from the medial side (B).

    The second Fibretape is passed proximally and the suture is passed through the lateral aspect of the triceps insertion.The Fibretape runs from B to C, then retrieved from point D.

    The second Fibretape is again retrieved and tensioned by taking any excess slack out of the sutures.The suture runs from A to D.

    The second Fibretape is passed back through the distal drill hole from medial to lateral.The Fibretape runs from D to E to F.

    The second Fibretape is retrieved from the lateral aspect of the drill hole.

    Any slack from sections B-C and D-E of Fibretape is removed and tensioned.

    The second Fibretape suture is crossed over the dorsal aspect of the olecranon and passed through the medial triceps insertion.The Fibretape suture runs from F to G and retrieved from H after it is passed through the medial aspect of triceps insertion.

    All the limbs of the first Fibretape can be tensioned and the two free ends are tied.

    The knot is laid on the lateral aspect of the olecranon.
    As the knot stack is bulky, it is best to lay it laterally where it can be buried and doesn’t irritate the soft tissues.
    The knot stack usually consists of 4-5 throws to lock and secure the suture to minimise the risk of the knot backing off.

    The second Fibretape is re-tensioned to take out any residual slack.

    Operation – 3

    The second Fibretape is secured and tied.
    The knot is again laid on the lateral aspect of the proximal ulna.

    The stabilising K-wire can be removed once the fracture has been reduced and fixed.

    This image shows the final construct with the elbow in flexion.
    This images shows that all limbs of the sutures are taut.
    The fracture is reduce and remains reduced and stable when stressed i.e. in flexion.

    Intra-operative AP fluoroscopic images to ensure the joint remains cronguent.

    Once tied-off the fixation should be be screened under image intensifier through a range of extension to full flexion to ensure that the reduction is maintained and secure when stressed.Intra-operative lateral fluoroscopic image of the elbow in flexion.
    Flexion will stress the integrity of the repair.
    If there is any concern regarding adequacy of the construct or any gapping noted, the repair can be augmented using an anatomic olecranon locking plate (see olecranon plating technique).

    Care is taken to close the fascia layer as best able using number 1 vicryl.It is usually possible to close the fascia primarily at the distal aspect of the wound (A).
    However, it is not usually possible to close this layer primarily towards the olecranon tip (B). At this level, the fascia is tagged and approximated as best able.

    The fat layer is closed using 2-0 vicryl.

    A subcuticular continuous stitch using 3-0 monocryl completes the soft tissue closure.

    1/2 inch steristrips are applied.

    The wound is sealed with a waterproof dressing.
    This is then wrapped in wool and crepe to minimise oozing and bleeding from the wound.

    AP radiograph of left elbow taken 3 months post fixation.
    The radiograph show that the elbow joint is congruent.

    Lateral radiograph of left elbow taken at 3 months post surgery showing that the congruency of the joint is maintained.
    The fracture reduction is maintained with evidence of healing at the fracture site.
    Note the distal transverse drill hole can still be seen (A).

    Post Operative

    The principle of a tension band fixation technique is that movement converts the tension forces into a compression force at a fracture when it is mobilised.
    The patient is not immobilised in plaster. A wool and crepe bandage is applied with the elbow in 45-90 degress of flexion and supported in a sling.
    Immediate active range of motion is allowed as soon as pain allows.
    The bandages are taken down at 48-72 hours. The wound is usually checked in clinic at around 2 weeks.
    Active movements against resistance should be avoided until there is evidence of bony healing at approximately 6–8 weeks to minimise the distracting force of the triceps on the fracture.

    Recommended Reading

    Phadnis J, Watts AC. Tension band suture fixation for olecranon fractures. Shoulder Elbow. 2017 Oct;9(4):299-303. doi: 10.1177/1758573216687305. Epub 2017 Jan 18.
    Single surgeon series of 28 patients treated with a tension band suture fixation for an acute fracture or olecranon osteotomy. Radiographic union was achieved in all patients. There was one incidence of malunion due to technical error and one incidence of heterotopic ossifcation. None of the patients required suture removal.
    Duckworth AD, Clement ND, White TO, Court-Brown CM, McQueen MM. Plate Versus Tension-Band Wire Fixation for Olecranon Fractures: A Prospective Randomized Trial. J Bone Joint Surg Am. 2017 Aug 2;99(15):1261-1273. doi: 10.2106/JBJS.16.00773.
    Duckworth et al. showed that there was no difference in outcome in fractures fixed either by metal tension band wiring or plating. However, hardware removal was higher in the metal tension band wire group – 50% vs 22% (p<0.02).
    In elderly patients of low functional demand, good functional outcomes can be achieved despite significant displacement. In a series of 13 patients treated non-operatively of mean age 81.8 years with >5 mm displacement, Veras Del Monte et al. found only one patient had a poor functional outcome.
    McKeever and Buck suggested that up to 80% of the trochlear notch could be excised without appreciably compromising elbow stability. Inhofe and Howard showed good or excellent outcomes in 11 of 12 cases treated with excision of up to 70% of the trochlear notch.
    Duckworth et al. showed that there was no difference in outcome in fractures fixed either by metal tension band wiring or plating. However, hardware removal was higher in the metal tension band wire group – 50% vs 22% (p<0.02).

    Reference

    • orthoracle.com

    Tags:

    You might be interested in

    Dark mode powered by Night Eye