The Use of High Strength Sutures and Anchors in Olecranon Fractures: A Systematic Review

Abstract

Purpose/Background: Olecranon fractures are common, particularly in the elderly osteoporotic population. Although various techniques of fixation are available, the gold standard—tension band wiring (TBW)—has high complication and reoperation rates. We sought to identify current evidence for the use of high-strength suture tension banding methods to determine whether they reduce complications and reoperation rates while maintaining fixation. Methods: A systematic review of several databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases included Cochrane, PubMed, MEDLINE and Embase. We searched for evidence of at least Level I to IV (according to NHMRC) of the use of tension band suturing or anchors in the surgical treatment of displaced olecranon fractures. We also analyzed the cost of fixation in our institute. Results: Four hundred and forty articles were identified. Of these, 9 met the inclusion criteria. One hundred thirty-one subjects had an average age of 66 years. All the studies showed that high-strength suture tension banding/anchoring maintained fixation with displaced olecranon fractures, reducing the complication rates and showed minimal reoperation rates. There was also a significant cost advantage of the suture tape construct mainly due to avoiding subsequent removal of metal. Conclusion: Tension band suturing or anchoring displaced olecranon fractures may be an alternative cost effective method to TBW in maintaining fixation, reducing metalware complications and reducing re-operation rates. Level of Evidence: IV.

Proximal ulna fractures in adults: A review of diagnosis and management

“…18 Although olecranon nails are commercially available, they are not widely used due to the lack of any strong clinical evidence. There has been some interest in the use of sutures with or without anchors for fixation of olecranon fractures with a recent systematic review 19 suggesting that FibreWire/SutureTape fixation and suture anchor fixation had similar union rates and significantly lower re-operation rates when compared to traditional TBW.…”

Fractura de olécranon. Nueva alternativa terapéutica

“…Nazifi y cols. 7 llevaron a cabo una revisión sistemática de estudios con nivel de evidencia I-V, sobre el uso de suturas fuertes y arpones para las fracturas de olécranon. Solo encontraron nueve artículos publicados, y concluyeron en que el uso de suturas es una alternativa costo-efectiva frente al alambre, ya que disminuye ampliamente la tasa de reoperación.…”

“…4 Se han descrito múltiples opciones quirúrgicas para el tratamiento de las fracturas de olécranon (clavijas con alambre, placas anatómicas, tornillos endomedulares canulados solos o con alambre, clavos endomedulares, banda de tensión con suturas solamente). [5][6][7] Todos estos métodos de fijación tienen como resultado la reducción anatómica, restaurar la movilidad y la consolidación de la fractura.…”

A Novel Suture‐Preset Spring Plate System (SSPS) for Comminuted Coronoid Process Fracture in the Elbow

“… 20 The suture anchors have a high prevalence of malunion and nonunion complication due to its limited holding strength of the fracture. 21 Further, a biomechanical comparison study of screw osteosynthesis and anatomical plating found that the plate osteosynthesis had better stability for large coronoid shear fractures. 22 However, in cases of coronoid fractures with comminution, the plate or suture could not provide enough stability individually.…”

“…A previous study showed that the lasso technique was more stable than the suture anchors or screws fixation alone 20 . The suture anchors have a high prevalence of malunion and nonunion complication due to its limited holding strength of the fracture 21 . Further, a biomechanical comparison study of screw osteosynthesis and anatomical plating found that the plate osteosynthesis had better stability for large coronoid shear fractures 22 .…”