Comparative analysis of Kirschner wire versus cancellous screw in tension band wiring for olecranon fractures: Optimizing fixation for functional recovery and repair

JOURNAL/rmrep/04.03/02273995-202601000-00001/figure1/v/2026-02-02T130752Z/r/image-tiff Objectives: Olecranon fractures constitute a significant proportion of proximal forearm injuries. Tension band wiring remains a mainstay of surgical treatment, with multiple fixation variants in practice. This study compares the clinical and functional outcomes of tension band wiring using either a single intramedullary cancellous screw or two parallel Kirschner wires (K-wires). This study aimed to compare functional and radiological outcomes of tension band wiring using a single cancellous screw versus two K-wires for olecranon fractures. Methods: This retrospective cohort study was conducted at a tertiary trauma center in Pakistan from February 2018 to December 2021. Patients aged 18–60 years with Mayo Type I–IIIA olecranon fractures were included. Patients were divided into two groups based on fixation technique: tension band wiring with dual K-wires (Group A) and tension band wiring with a single cancellous screw (Group B). The primary outcome was the Mayo Elbow Performance Score for evaluating the functional outcome at 3, 6, and 12 months postoperatively. The secondary outcomes included radiological union time, complication rates (e.g., hardware prominence), and reoperation rates for implant removal. Results: At 1-year follow-up, the mean Mayo Elbow Performance Score was significantly higher in Group A (91.5 ± 7.2) than in Group B (87.2 ± 8.5, P = 0.03). Excellent outcomes were observed in 73.6% of patients in Group A versus 60.5% in Group B. Group A had fewer complications including hardware prominence (13.1% vs . 23.6%) and lower reoperation rates for implant removal (15.7% vs . 26.3%). All fractures achieved union within a mean duration of 14 weeks. Conclusion: Tension band wiring using two parallel K-wires yields superior functional outcomes and fewer complications compared to the use of a single cancellous screw. It remains the preferred method for simple olecranon fractures due to its reliability and lower implant-related morbidity.