All patients were immobilized with a long-arm cast or splint for two to four weeks post-operatively. Fixation construct was based on physician preference. Operative treatment was with a TBW construct or tension band suture (TBS) construct with nonabsorbable braided suture. Patients were identified by International Classification of Disease (ICD)-9 ( ), ICD-10 ( ) and Current Procedural Terminology (CPT) codes. Figure 1 illustrates the radiographic appearance of tension band fixation constructs with wire and suture.Īll patients less than 18 years of age diagnosed with a displaced transverse intra-articular olecranon fracture and treated with tension band fixation between January 2008 to May 2017 at a single centre were retrospectively enrolled in this institutional review board-approved study. Substituting braided, nonabsorbable suture for the 18-gauge wire in the tension band construct has grown in popularity and is theorized to potentially be less prominent and painful. 2 Tension band wires (TBWs) in active children with a thin subcutaneous layer can be especially prominent and painful and necessitate a return trip to the operating room for hardware removal. 5 Although tension band fixation has been shown to provide articular compression and resist high loads prior to failure, this technique is also associated with painful hardware resulting in implant removal in up to 88% of patients. A transverse hole is drilled in the ulna distal to the fracture site, a steel wire is passed through the bone, and then a figure-of-eight tension band is constructed to incorporate the K-wires. Traditionally, this technique involves fracture reduction followed by the placement of two parallel Kirschner (K)-wires placed through the olecranon and across the fracture site. Tension band fixation is the standard of care for displaced transverse intra-articular fracture of the olecranon. Multiple studies in adults have described and compared outcomes of these various fixation strategies 2, 5– 7 and the fracture pattern often dictates the type of fixation. There are multiple strategies for fixation, including plates, compression screws and tension band constructs. 1 Displaced intra-articular olecranon fractures are most commonly treated with open reduction and internal fixation. See Instructions for Authors for a complete description of levels of evidence.Fractures of the olecranon represent approximately 5% of all elbow fractures in children. Functional nonunion can be anticipated if nonoperative treatment is elected in low-demand elderly patients. Surgical intervention carried a high risk of reoperation regardless of whether plate or TBW fixation was used. Prevalence and 95% confidence intervals (CI) were calculated for dichotomous variables, while weighted means and CI were calculated for continuous variables.Ĭomparable outcomes were achieved with surgical or nonoperative management of olecranon fractures in geriatric patients. Separate random effects meta-analyses were conducted for each outcome according to intervention. The interventions included for analysis were tension band wire (TWB) fixation, plate fixation, or nonoperative management. PubMed, Web of Science, and Embase databases.Īrticles were included if they contained clinical data evaluating outcomes in patients ≥65 years of age with closed olecranon fractures, without elbow instability, treated surgically, or with nonoperative management.ĭata regarding patient age, olecranon fracture type, fracture union, adverse events, reoperation, elbow range of motion, and surgeon and patient reported outcome measures were recorded according to intervention. The aim of this comparative effectiveness study was to perform a meta-analysis of adverse events and outcomes in closed geriatric olecranon fractures, without elbow instability, after treatment with surgical or nonoperative management.
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