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Midterm outcomes of suture anchor fixation for displaced olecranon fractures

  • Michael J. Gutman (Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals) ;
  • Jacob M. Kirsch (Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals) ;
  • Jonathan Koa (Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals) ;
  • Mohamad Y. Fares (Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals) ;
  • Joseph A. Abboud (Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospitals)
  • Received : 2023.06.22
  • Accepted : 2023.08.04
  • Published : 2024.03.01

Abstract

Background: Displaced olecranon fractures constitute a challenging problem for elbow surgeons. The purpose of this study is to evaluate the role of suture anchor fixation for treating patients with displaced olecranon fractures. Methods: A retrospective review was performed for all consecutive patients with displaced olecranon fractures treated with suture anchor fixation with at least 2 years of clinical follow-up. Surgical repair was performed acutely in all cases with nonmetallic suture anchors in a double-row configuration utilizing suture augmentation via the triceps tendon. Osseous union and perioperative complications were uniformly assessed. Results: Suture anchor fixation was performed on 17 patients with displaced olecranon fractures. Functional outcome scores were collected from 12 patients (70.6%). The mean age at the time of surgery was 65.6 years, and the mean follow-up was 5.6 years. Sixteen of 17 patients (94%) achieved osseous union in an acceptable position. No hardware-related complications or fixation failure occurred. Mean postoperative shortened disabilities of the arm, shoulder, and hand (QuickDASH) score was 3.8±6.9, and mean Oxford Elbow Score was 47.5±1.0, with nine patients (75%) achieving a perfect score. Conclusions: Suture anchor fixation of displaced olecranon fractures resulted in excellent midterm functional outcomes. Additionally, this technique resulted in high rates of osseous union without any hardware-related complications or fixation failures.

Keywords

References

  1. Duckworth AD, Bugler KE, Clement ND, Court-Brown CM, McQueen MM. Nonoperative management of displaced olecranon fractures in low-demand elderly patients. J Bone Joint Surg Am 2014;96:67-72.  https://doi.org/10.2106/JBJS.L.01137
  2. Duckworth AD, Clement ND, Aitken SA, Court-Brown CM, McQueen MM. The epidemiology of fractures of the proximal ulna. Injury 2012;43:343-6.  https://doi.org/10.1016/j.injury.2011.10.017
  3. Bailey CS, MacDermid J, Patterson SD, King GJ. Outcome of plate fixation of olecranon fractures. J Orthop Trauma 2001;15:542-8.  https://doi.org/10.1097/00005131-200111000-00002
  4. Buijze G, Kloen P. Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures. J Bone Joint Surg Am 2009;91:2416-20.  https://doi.org/10.2106/JBJS.H.01419
  5. Duckworth AD, Clement ND, McEachan JE, White TO, Court-Brown CM, McQueen MM. Prospective randomised trial of non-operative versus operative management of olecranon fractures in the elderly. Bone Joint J 2017;99:964-72.  https://doi.org/10.1302/0301-620X.99B7.BJJ-2016-1112.R2
  6. Edwards SG, Cohen MS, Lattanza LL, et al. Surgeon perceptions and patient outcomes regarding proximal ulna fixation: a multicenter experience. J Shoulder Elbow Surg 2012;21:1637-43.  https://doi.org/10.1016/j.jse.2011.11.024
  7. Romero JM, Miran A, Jensen CH. Complications and re-operation rate after tension-band wiring of olecranon fractures. J Orthop Sci 2000;5:318-20.  https://doi.org/10.1007/s007760070036
  8. Duckworth AD, Clement ND, White TO, Court-Brown CM, McQueen MM. Plate versus tension-band wire fixation for olecranon fractures: a prospective randomized trial. J Bone Joint Surg Am 2017;99:1261-73.  https://doi.org/10.2106/JBJS.16.00773
  9. Snoddy MC, Lang MF, An TJ, et al. Olecranon fractures: factors influencing re-operation. Int Orthop 2014;38:1711-6.  https://doi.org/10.1007/s00264-014-2378-y
  10. Campbell ST, DeBaun MR, Goodnough LH, Bishop JA, Gardner MJ. Geriatric olecranon fractures treated with plate fixation have low complication rates. Curr Orthop Pract 2019;30:353-5.  https://doi.org/10.1097/BCO.0000000000000765
  11. Bateman DK, Barlow JD, VanBeek C, Abboud JA. Suture anchor fixation of displaced olecranon fractures in the elderly: a case series and surgical technique. J Shoulder Elbow Surg 2015;24:1090-7.  https://doi.org/10.1016/j.jse.2015.02.017
  12. Hak DJ, Golladay GJ. Olecranon fractures: treatment options. J Am Acad Orthop Surg 2000;8:266-75.  https://doi.org/10.5435/00124635-200007000-00007
  13. Hutchinson DT, Horwitz DS, Ha G, Thomas CW, Bachus KN. Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am 2003;85:831-7.  https://doi.org/10.2106/00004623-200305000-00010
  14. Wild JR, Askam BM, Margolis DS, Geffre CP, Krupinski EA, Truchan LM. Biomechanical evaluation of suture-augmented locking plate fixation for proximal third fractures of the olecranon. J Orthop Trauma 2012;26:533-8.  https://doi.org/10.1097/BOT.0b013e318239273c
  15. Izzi J, Athwal GS. An off-loading triceps suture for augmentation of plate fixation in comminuted osteoporotic fractures of the olecranon. J Orthop Trauma 2012;26:59-61.  https://doi.org/10.1097/BOT.0b013e318214e64c
  16. Baecher N, Edwards S. Olecranon fractures. J Hand Surg Am 2013;38:593-604.  https://doi.org/10.1016/j.jhsa.2012.12.036
  17. Wilson J, Bajwa A, Kamath V, Rangan A. Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J Bone Joint Surg Br 2011;93:245-50.  https://doi.org/10.1302/0301-620X.93B2.24613
  18. Powell AJ, Farhan-Alanie OM, McGraw IW. Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reoperations and economics. Musculoskelet Surg 2019;103:155-60.  https://doi.org/10.1007/s12306-018-0556-6
  19. Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD. Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res 2008;3:9. 
  20. Ernstbrunner L, Rupasinghe HS, Almond M, et al. A new all-suture tension band tape fixation technique for simple olecranon fractures versus conventional tension band wire fixation: a comparative biomechanics study. J Shoulder Elbow Surg 2022;31:1376-84.  https://doi.org/10.1016/j.jse.2022.01.130
  21. Cook E, James S, Watts AC, The SOFFT team. A randomized controlled trial to compare clinical and cost-effectiveness of suture fixation versus tension band wiring for simple olecranon fracture fixation in adults: the Simple Olecranon Fracture Fixation Trial (SOFFT) protocol. Bone Jt Open 2023;4:27-37.  https://doi.org/10.1302/2633-1462.41.BJO-2022-0132.R1
  22. von Keudell A, Kachooei A, Mohamadi A, et al. Biomechanical properties of an intramedullary suture anchor fixation compared to tension band wiring in osteoporotic olecranon fractures: a cadaveric study. J Orthop 2020;17:144-9.  https://doi.org/10.1016/j.jor.2019.08.002
  23. Hume MC, Wiss DA. Olecranon fractures: a clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Relat Res 1992;229-35. 
  24. Karlsson MK, Hasserius R, Karlsson C, Besjakov J, Josefsson PO. Fractures of the olecranon: a 15- to 25-year followup of 73 patients. Clin Orthop Relat Res 2002;205-12.