Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients.

INTRODUCTION: Tension band wiring of olecranon fractures has high reported rates of complications and reoperations. We aimed to compare classic tension band wiring to cerclage fixation without K-wires in the treatment of displaced olecranon fractures in elderly patients. The primary outcome was reoperation. Secondary outcomes included complications and patient reported outcomes. Outcomes following non-operative treatment were also studied.

MATERIALS AND METHODS: Patients aged > 69 years presenting with Mayo class 2a and 2b olecranon fractures at our institution from 2004 through 2016 (n = 239) were eligible for study. Fracture type, treatment method, complications and reoperations were assessed from radiographs and hospital files. QuickDASH surveys were collected by mail.

RESULTS: Patients operated with tension band wire technique had more reoperations (p value 0.03): relative risk (RR) 2.2 (CI 1.08-4.3), odds ratio (OR) 2.6 (CI 1.05-6.4), and complications (p value 0.001): RR 2.5 (CI 1.51-4.1), OR 3.7 (CI 1.67-8.2), compared with those operated with cerclage technique. Non-operative treatment yielded similar complication (p value 0.2) and reoperation rates (p value 0.06) as cerclage fixation. The answer rate was insufficient to compare QuickDASH scores between treatments methods.

CONCLUSIONS: In patients 70 years and older undergoing cerclage fixation for displaced stable olecranon fractures (Mayo class 2), the reoperation and complications rates were less than half of those in patients undergoing TBW fixation. Non-operative treatment yielded similar reoperation and complication rates to cerclage fixation, in selected cases.

LEVEL OF EVIDENCE: III-retrospective comparative cohort study.