Is there literature on treating olecranon fractures with a plate plus tension band construct?

Literature on Olecranon Fracture Treatment with Plate Plus Tension Band Construct

There is no specific case report or literature directly examining olecranon fractures treated with a combined plate plus tension band construct in the provided evidence.

Current Treatment Options for Olecranon Fractures

The management of olecranon fractures primarily involves two established fixation methods:

Tension Band Wiring (TBW)

• Traditional standard treatment for transverse olecranon fractures 1
• Converts tensile forces into compressive forces at the fracture site
• Different configurations exist based on Kirschner wire placement:
  • Proximal ulnar canal (associated with higher migration rates)
  • Through anterior ulnar cortex
  • Distal ulnar canal (potentially most effective approach) 2
• Limitations:
  • High complication rates (42% symptomatic hardware prominence) 3
  • Significant postoperative loss of reduction (53%) 3
  • Hardware failure commonly occurs at the metal wire twists 4

Plate Fixation

• Increasingly used alternative to TBW
• Advantages over TBW:
  • Better maintenance of reduction (only 5% loss of reduction vs 53% with TBW) 3
  • Superior roentgenographic results (86% good results vs 47% with TBW) 3
  • Better clinical outcomes (63% good results vs 37% with TBW) 3
  • Higher construct stiffness in initial loading 4
  • Lower rate of hardware failure 4
• Disadvantages:
  • Longer operative time 3

Novel Approaches

• Low-profile olecranon tension plates (OTP) with angular stable screws have been tested as alternatives to traditional TBW
• These plates incorporate principles of pre-tensioning, lag, cortical, and angular stable screws
• Biomechanical studies show similar stability to TBW in complex fracture models 5

Implications for Clinical Practice

While the evidence does not specifically address a combined plate plus tension band construct, the literature suggests:

1. Both TBW and plate fixation are valid treatment options for olecranon fractures
2. Plate fixation may offer advantages in terms of maintaining reduction and reducing hardware-related complications
3. The choice of fixation method should consider:
   • Fracture pattern (comminution may benefit from plate fixation) 6
   • Need for early functional mobilization 1
   • Risk of hardware-related complications

Conclusion

The current literature focuses on comparing tension band wiring versus plate fixation as separate techniques rather than as a combined construct. Further research specifically investigating the combined plate plus tension band construct for olecranon fractures would be valuable to determine if this approach offers advantages over existing techniques.