From the Guidelines
Plate fixation is the recommended treatment for complex olecranon fractures, including those with articular involvement, comminution, or poor bone quality, due to its ability to provide superior stability and restore articular congruity. The use of plate fixation in olecranon fractures is supported by the fact that it allows for more rigid fixation and better restoration of articular congruity compared to tension band wiring 1. In the context of elbow trauma, CT scans have been shown to be useful in identifying and clarifying fracture morphology, including fractures of the olecranon, radial head, and coronoid process 1.
Some key points to consider when using plate fixation for olecranon fractures include:
- The use of a contoured 3.5mm dynamic compression plate or pre-contoured olecranon-specific plate placed on the dorsal surface of the ulna
- The use of 3.5mm cortical screws proximally and distally
- The potential benefits of using a locking plate system for highly comminuted fractures
- The importance of early protected range of motion and progressive strengthening postoperatively
It is also important to note that plate fixation requires more extensive soft tissue dissection and carries risks of hardware prominence, especially in patients with limited soft tissue coverage. However, the biomechanical advantage of plate fixation makes it a preferred treatment option for complex olecranon fractures, particularly those with oblique patterns, comminution, or extension into the coronoid process 1.
In terms of specific treatment protocols, the following may be considered:
- Early protected range of motion within 1-2 weeks postoperatively
- Progressive strengthening at 6-8 weeks postoperatively
- Regular follow-up to monitor for hardware prominence or other complications.
From the Research
Plate Fixation in Olecranon Fractures
- Plate fixation is an effective treatment option for displaced olecranon fractures, with a good functional outcome and a low incidence of complications 2.
- The outcome of plate fixation is not influenced by fracture pattern, and it is a suitable option for both simple and comminuted fractures 2.
- A survey of Canadian surgeons found that plating is the preferred treatment for displaced comminuted olecranon fractures (Mayo IIB), while tension band wiring is preferred for simple displaced fractures (Mayo IIA) 3.
Comparison with Tension Band Wiring
- A study comparing plate fixation and tension band wiring found that both methods have similar outcomes, but plate fixation requires longer operative time and has a higher incidence of metalwork-associated complications 4.
- Another study found that plate fixation resulted in better clinical and radiographic results compared to tension band wiring, with a lower rate of postoperative loss of reduction and symptomatic metal prominence 5.
- Tension band suture fixation is an alternative method that aims to reduce the rate of re-operation caused by prominent metalwork, but its effectiveness compared to plate fixation is not well established 6.
Complications and Outcomes
- The most common complication associated with plate fixation is hardware prominence, which occurs in approximately 20% of patients 2.
- Plate fixation can result in excellent or good outcomes, with high patient satisfaction and low pain ratings, as measured by the Mayo Elbow Performance Index (MEPI) and visual analogue scales 2.
- The functional outcome of plate fixation is similar to that of tension band wiring, with no significant differences in range of motion, strength, or return to work time 4.