OUTCOMES OF ALL-SUTURE TENSION BAND TECHNIQUE FOR FIXATION OF OLECRANON FRACTURES: A RETROSPECTIVE CASE SERIES

Olecranon fractures are a common orthopedic injury that account for approximately 10% of upper extremity injuries. These injuries have a bimodal distribution with the high energy injuries primarily affecting a younger population and low energy falls affecting the elderly. Tension band wiring is one of the earliest and most common techniques for the fixation of olecranon fractures. Tension band wiring has been shown to result in good functional outcomes but has been fraught with complications related to hardware migration and irritation. Reoperations rates after tension band wiring have been reported as 33.3%-79.2%. Although low-profile, pre-contoured plates have improved the hardware-related complications compared to tension band wiring, hardware removal secondary to plate irritation is still not that uncommon with reported rates ranging from 15%-56%. All-suture tension band technique is a novel technique for fixation of select olecranon fractures which have been shown to have equivalent or superior biomechanical performance to tension band wiring and avoid its hardware-related complications. However, outcomes of this fixation technique are not yet well-reported.The goal of this study was to evaluate the clinical and radiographic outcomes of patients who underwent all-suture tension band fixation of their olecranon fractures. This study was a retrospective case series of 15 patients with transverse olecranon fracture who underwent all-suture tension band fixation. The operated extremity was placed in a sling after the operation which was removed at the first postoperative visit (~2 weeks postoperatively) and the patients were allowed to work on range of motion (ROM) as tolerated. ROM at 6 weeks and at the time of final follow-up as well as the rate of union were evaluated. Patients charts and perioperative radiographs were evaluated for any complications including but not limited to infection, neurovascular injury, and any reoperations were also recorded, patients reported outcomes were collected prospectively post-operatively using PREE, qDASH and SANE scores. The mean age of patients in our cohort was 55±14, 66% were females. Our average follow-up time was 5±5 months. The patients achieved an average elbow arc of motion of 108°±28° at 6 weeks (extension -21°±8°; flexion 129°±23°) which improved to 133°±13° at the final follow-up (extension -13°±8°; flexion 146°±6°). They also achieve an average forearm arc of rotation of 156°±9° at 6 weeks (supination 80°±7°; pronation 76°±10°) and 157°±8° at the final follow-up (supination 83°±7°; pronation 74°±6°). At the time of final follow-up, patients reported average PREE of 15.8±5.1, qDASH of 10.1±10.2, and SANE score of 93.8±7.6. All patients achieved clinical and radiographic union by the final follow. No clinical or radiographic complications or reoperations were noted during the follow-up period. All-suture tension band technique is a viable option for the management of simple olecranon fractures or fractures with minimal comminution that can be converted to a simple fracture pattern. This technique yields excellent clinical outcomes and avoid hardware related complications associated with tension band wiring and plate fixation. There were no cases of nonunion or reoperation in our cases series. Larger cohorts and randomized clinical trials are needed to confirm these findings.