Biomechanical comparison of tension band suture fixation and tension band wiring in olecranon fractures

• Published in: Injury 2023-08, Vol.54 (8), p.110919-110919, Article 110919
• Main Authors: Vesterby, Liv, Haugaard, Asger Martin, Adjal, Jonas, Muhudin, Huda Ibrahim, Sert, Kevser, Thomsen, Morten Grove, Ban, Ilija, Ohrt-Nissen, Søren
• Format: Article
• Language: English
• Subjects: Biomechanical; Biomechanical Phenomena; Bone Wires; Cadaver; Forearm fracture; Fracture Fixation, Internal - methods; Fractures, Bone - surgery; Humans; Olecranon Fracture; Olecranon Process - surgery; Postoperative Complications; Sutures; Tension band suture fixation; Tension band wiring; Ulna Fractures - surgery
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.110919

•Fracture reduction and fixation of a transverse olecranon fracture was carried out using either tension band wire fixation or all-suture fixation.•We found no difference between the techniques in terms of fracture displacement after 200 cycles of loading to 300 N.•This all-suture based technique has the potential to lower implant-related complications. Traditional tension band wire fixation (TBWF) of olecranon fractures is associated with high revision rates due to implant-related complications. The purpose of the study was to compare the strength of fixation in olecranon fractures between TBWF and an all-suture based technique. A transverse fracture was created in 20 paired fresh-frozen human cadaveric elbows. Fractures were randomly (alternating right-left) assigned for fixation with either tension band suture fixation (TBSF) or TBWF. The elbow was fixed in 90° of flexion and underwent cycling loading by pulling the triceps tendon to 300 N for 200 cycles. Fracture displacement was optically recorded using digital image correlation (DIC). Finally, load-to-failure was assessed by a monotonic pull to 1000 N and failure mechanism was recorded. Two specimens in the TBSF group were excluded from the cycling loading analysis due to technical difficulties with the DIC. After cyclic loading, median (min-max) fracture displacement was 0.28 mm (0.10–0.44) in the TBSF group and 0.18 mm (0.00–1.48) in the TBWF group (p = 0.315). No difference was found between the two groups in the repeated measures analysis of variance (p = 0.329). In the load-to-failure test, 6/10 specimens failed in the TBSF group (median load-to-failure 791 N) vs. 8/10 in the TBWF group (median load-to-failure 747 N). The TBSF constructs failed due to fracture of the dorsal cortex, suture breakage or triceps failure. The TBWF constructs failed due to breakage of the wire. There was no difference in fixation strength between the TBWF and TBSF constructs. Our findings suggest TBSF to be a feasible alternative to TBWF and we hypothesize that a non-metallic implant may have fewer implant-related complications. Basic science study