A survey of current practices and preferences for internal fixation of displaced olecranon fractures

Abstract

Background: Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons' practices and preferences for internal fixation methods for displaced olecranon fractures. Methods:Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures. Results:We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5-37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73-83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5-85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17-3.45) and comminution with a mean impact of 3.34 (95% CI 3.21-3.46) were the 2 factors influencing surgeons' choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69-80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4-81.7%) and 76.2% (95% CI 70.6-81.0%) for tension band wiring and plating, respectively. Conclusion:Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures.

Intramedullary screw fixation for simple displaced olecranon fractures

“…Previous studies have suggested that fixation using intramedullary cannulated screws is technically challenging and unreliable [11,[15][16][17][18], but we found that this technique lead to acceptable surgical results, good patient-reported outcomes, and low rates of implant removal with reasonable operative times (average 45 min). When surgical treatment is indicated, several treatment options, such as tension-band wiring, plate fixation, intramedullary screw fixation and intramedullary nail fixation have been described [1][2][3][4][5][7][8][9][10][11]. These techniques differ in their method of fixation and have their own advantages and disadvantages, but a recent Cochrane review found that none was definitively preferable based on available evidence [2].…”

“…These techniques differ in their method of fixation and have their own advantages and disadvantages, but a recent Cochrane review found that none was definitively preferable based on available evidence [2]. Tension-band wiring has shown excellent results with regard to union rates [2,3,9] and remains the first choice of treatment for many due to the low complexity and costs of the [8,9]. Yet, implant removal is often necessary due to hardware irritation or k-wire migration in up to 82% of patients [3,7].…”

“…As a result, this injury is typically treated with open reduction and internal fixation (ORIF) [1][2][3][4][5]. Common techniques to treat simple olecranon fractures are tension-band wiring and plate fixation [1][2][3][4][5][6][7][8][9][10][11]. As the skin is thin at the proximal ulna with relatively little subcutaneous tissue, these fixation methods often lead to implant-related soft-tissue irritation necessitating implant removal in 68-82% of the cases largely based on the fixation method that was used [3][4][5]12].…”

Surgical Treatment of Olecranon Fractures

“…In one study from Canada, most surgeons have shown a preference for TBW in simple displaced olecranon fractures and for plating in displaced, comminuted olecranon fractures. 28) Although TBW is the most common treatment for simple transverse fractures, current evidence demonstrates that the clinical outcomes of locked plating and TBW are comparable, while the plating provides greater construct stability and fewer symptomatic hardware problems. We should understand the unique anatomy of proximal ulna and the fracture geometry.…”

“…28) Bioabsorbable fixation can obviate those hardwarerelated complications and completely deviates the need for secondary surgery to remove hardware. 29) The clinical outcomes of bioabsorbable implants (poly-L-lactide wire with selfreinforced polyglycolide screws or self-reinforced poly-L-lactide plugs) have been shown to be comparable to those of metallic implants, as in K-wires used in TBW.…”