Tension band suture fixation for olecranon fractures

Abstract

Olecranon fractures are common and often require surgical treatment when displaced. Traditional methods of stabilization using tension band wire fixation and plate fixation achieve adequate union and function but are associated with a high rate of re-operation and wound problems because of prominent metalwork. The purpose of the present article is to describe an all suture technique for fixation of simple olecranon fractures that maintains inter-fragmentary compression, provides bony union and reduces the rate of re-operation caused by prominent metalwork.

Keywords: fixation; fracture; olecranon; olecranon osteotomy; suture; tension band.

Figures

Figure 1.

(a) A typical transverse olecranon fracture treated using the suture technique. There is no translation of the dorsal cortex of the ulna and the ulnohumeral joint is congruent. The direction of force (dotted arrow) is in the line of the triceps. (b) Ulnohumeral instability following an olecranon fracture. Note the ulnohumeral incongruity and step in the dorsal cortex of the ulna created by translation of the proximal fragment relative to the ulna shaft. The dotted arrow indicates the direction of force. Plate fixation is advocated for this fracture.

Figure 2.

Schematic diagram of the suture technique. (a) Transverse olecranon fracture. (b) Creation of transverse tunnel distal to the fracture. (c) Placement of first longitudinal suture loop. (d) placement of second figure of eight suture loop. The knots are not illustrated here but are tied on the lateral aspect of the olecranon.

Figure 3.

In vivo final construct following suture fixation.

Figure 4.

Example of a postoperative X ray demonstrating anatomic articular reduction and bony union at 8 weeks post operatively.