Tension Band Wiring Versus Precontoured Plate Fixation for 2-Part and Multifragmented Olecranon Fractures

Background: We conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures. Methods: We recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months. Results: More patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery. Conclusions: When treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.