From the Research
Dual plate fixation is generally superior to single plate fixation for complex olecranon fractures, particularly comminuted fractures or those with significant instability, as it provides enhanced biomechanical stability with improved resistance to displacement forces and lower rates of hardware failure, as demonstrated in a recent biomechanical study 1.
Key Points
- Dual plate constructs, typically using a dorsal plate with an additional medial or lateral plate, offer improved maintenance of reduction, decreased rates of nonunion, and better functional outcomes for complex fractures.
- However, dual plating comes with potential drawbacks, including increased surgical time, greater soft tissue dissection, higher risk of hardware prominence requiring removal, and potentially increased infection rates.
- Single plate fixation remains appropriate for simple, non-comminuted fractures where it provides adequate stability with less surgical morbidity.
- The decision between single versus dual plating should be individualized based on fracture pattern, bone quality, patient factors, and surgeon experience, with consideration of the findings from a study comparing tension band wiring and plate fixation techniques 2.
Considerations
- For most Mayo type II and III fractures with comminution, dual plating offers biomechanical advantages that may justify the more extensive surgical approach, as supported by a study on plate fixation and tension band wiring after isolated olecranon fracture comparison of outcome and complications 3.
- Simple transverse fractures can typically be managed effectively with single plate fixation, but the choice of fixation method should be guided by the specific fracture characteristics and patient needs, as discussed in a study on simple and comminuted displaced olecranon fractures 2.
- A study on tension band suture fixation for olecranon fractures highlights the importance of considering alternative fixation methods to minimize hardware prominence and promote better functional outcomes 4.
- Another study on percutaneous double-screw fixation for isolated fractures of the olecranon demonstrates the potential benefits of this approach in terms of reduced hardware removal and improved cosmetic results 5.