Journal of Musculoskeletal Trauma

Comparison of outcomes of reinforced tension band wiring and precontoured plate and screw fixation in the management of Mayo type IIIB olecranon fractures: Hyun Goo Kang, Tong Joo Lee, Samuel Jaeyoon Won; J Musculoskelet Trauma 2025;38(2):96-101. Published online February 28, 2025; DOI: https://doi.org/10.12671/jmt.2025.00059

Abstract PDF: Background
Mayo type IIIB olecranon fractures are characterized by significant displacement and comminution, presenting a challenge in selecting the appropriate fixation technique. This study compared the clinical and radiographic outcomes, complications, and reoperation rates of reinforced tension band wiring (TBW) and precontoured plate and screw fixation (PF) in the surgical treatment of Mayo type IIIB olecranon fractures.
Methods
This retrospective review analyzed 24 patients diagnosed with Mayo type IIIB olecranon fractures, who were treated between 2005 and 2023. Of these, 11 patients underwent reinforced TBW, and 13 received precontoured PF. Clinical outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes focused on fracture union. Operative times, complication rates, and reoperation rates were compared between the groups.
Results
Both the reinforced TBW and PF groups achieved satisfactory clinical outcomes, with no significant between-group differences in DASH and MEPS scores (P>0.05). Radiographic union was achieved in all patients. The reinforced TBW group demonstrated a significantly shorter operative time than the PF group (93.6±7.4 min vs. 132.3±13.7 min; P<0.001). Complication rates were similar between the two groups (reinforced TBW, 38.4%; PF, 36.3%), but hardware-related irritation occurred more frequently in the reinforced TBW group. Reoperations were required in 15.8% of the reinforced TBW group due to hardware irritation, whereas no reoperations were necessary in the PF group.
Conclusions
Reinforced TBW and PF are both effective surgical options for managing Mayo type IIIB olecranon fractures, yielding comparable clinical and radiographic outcomes. While reinforced TBW offers shorter operative times and lower costs, PF is associated with fewer hardware-related complications. Further prospective studies are needed to optimize treatment strategies for these complex fractures. Level of Evidence: Level III.

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Is It Essential to Apply Tension Band Wire Fixation in Non-Comminuted Displaced Transverse Fractures of the Olecranon (Mayo Type 2A)?: In-Tae Hong, Cheungsoo Ha, Seongmin Jo, Wooyeol Ahn, Soo-Hong Han; J Korean Fract Soc 2022;35(3):97-102. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.97

Abstract PDF: Purpose
Various problems have been reported with tension-band wire (TBW) fixation. With the devel-opment of anatomical plates and the improvement of fixation forces, plate fixation is currently being performed for non-comminuted, displaced, transverse olecranon fractures (Mayo Type 2A). This study compared the usefulness of the above two procedures applied in non-comminuted, displaced, transverse olecranon fractures.
Materials and Methods
Fifty-three patients with Mayo Type 2A were studied retrospectively. Twenty-nine patients underwent TBW fixation, while the other 24 underwent plate fixation. The averageoutpatient follow-up period was 10 months for both groups. Both groups were analyzed radiologically and clinically. The radiological assessment included the time to bone union, joint stability, and presence of traumatic osteoarthritis at the final follow-up. The clinical assessment included the operation time,range of motion of the elbow joint, Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) score, and the presence of postoperative complications.
Results
Both groups showed stable elbow joints, proper union of fractures, and no traumatic osteo-arthritis at the final follow-up. The range of motion for the TBW fixation group was 142° (range, 3°-145°), while that of the plate fixation group was 135° (range, 4°-139°) at the final follow-up (p=0.219). The MEPS was 98.2 and 97.7 for the TBW fixation and plate fixation groups, respectively (p=0.675). The DASH score was 10.7 and 13.9 for the TBW fixation and plate fixation groups, respectively. Both groups showed excellent results, and the differences were not statistically significant (p=0.289).
Conclusion
TBW fixation and plate fixation were compared in non-comminuted, displaced, transverse olecranon fractures, and good results were obtained without significant differences between the two groups. Hence, surgeons should choose a technique they are more confident with and can be applied more efficiently.

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Treatment of Olecranon Fractures with Proximal Ulna Comminution Using Locking Compression Plates: Ki Do Hong, Tae Ho Kim, Jae Cheon Sim, Sung Sik Ha, Min Chul Sung, Jong Hyun Jeon; J Korean Fract Soc 2015;28(1):59-64. Published online January 31, 2015; DOI: https://doi.org/10.12671/jkfs.2015.28.1.59

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the clinical results of locking compression plate (LCP) fixation for olecranon fractures with proximal ulna comminution.
MATERIALS AND METHODS
We review 10 cases of olecranon fractures with proximal ulna comminution treated with LCPs from August 2011 to August 2013. Follow-up period was from 12 months to 18 months. Mean age was 63.1 years (35-84 years). According to the Mayo classification, there were eight type IIB, and two type IIIB fractures. We used Mayo classification. Clinical evaluation was performed based on radiographic union of olecranon and measurements of range of motion at last follow-up. Disability of the arm, shoulder and hand (DASH) score and Mayo elbow performance score (MEPS) were used for evaluation of functional recovery.
RESULTS
All patients had bone union. According to the MEPS, nine of ten patients had a good or excellent outcome. The mean DASH score was 18.6. All cases started postoperative range of motion (ROM) within 14 days. Elbow ROM was more than 110degrees in all cases except one. Mean radiological bony union time was 4.2 months (2.5-6.0 months) postoperatively. Complication was hardware irritation in three patients.
CONCLUSION
Internal fixation using LCP for olecranon fractures with proximal ulna comminution can be a good treatment option which obtains good clinical results and enables early ROM.

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Treatment of Ulnar Olecranon Fracture Using Acutrak Screw: Hyungchun Kim, Kwangryul Kim, Moonsup Lim, Youngil Park, Inhwan Hwang, Jihoon Lee; J Korean Fract Soc 2009;22(4):270-275. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.270

Abstract PDF: PURPOSE
To evaluate the clinical results of Acutrak screw fixation for ulnar olecranon fractures. MATERIALS AND METHODS: We reviewed 15 cases of ulnar olecranon fractures which were treated with Acutrak screws from February 2003 to September 2007. Follow-up period is from 12 months to 42 months. We used Mayo classification. Radiologic results were analyzed according to step-off, gap, reduction loss, and functional results were analyzed according to pain and ROM. We analyzed union time, operation time, incision size and complications. RESULTS: In functional results, there were 3 good cases out of 3 Mayo type IA, 8 good cases and 2 fair cases out of 10 type IIA, 1 fair case and 1 poor case out of 2 type IIB. In radiologic results, there was 1 case of reduction loss. Average union time was 9.4 weeks, average operation time was 24 minutes and average incision size was 1.8 cm. CONCLUSION: We conclude that Acutrak screw fixation can be a treatment option for olecranon fracture of Mayo type IA and IIA.

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Treatment of Transolecranon Fracture-Dislocation of the Elbow: Soo Yong Kang, Han Jun Lee, Jung Nam Han, Kyoung Hwan Kim; J Korean Soc Fract 2001;14(1):99-105. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.99

Abstract PDF: PURPOSE
We conducted this study to discriminate transolecranon fracture-dislocation of the elbow from the anterior Monteggia lesion and to validate the differences of method of treatment.
MATERIALS AND METHOD
From March, 1998 to May, 1999, 3 cases of the transolecranon fracture-dislocation of the elbow were treated by open reduction and internal fixation.One of the three patients had simple oblique fracture of the olecranon combined with capitellum fracture and two had complex comminuted fracture of the olecranon. Functional outcome was assessed with elbow performance rating system of Broberg and Morrey.
RESULTS
At a minimum follow-up of 12 months, overall outcome was rated as exellent in two patients, fair in one. Average bone union peoriod was three months.
CONCLUSION
Stable restoration of the accurate contour and dimension of the trochlear notch of the olecranon and early ROM exercise will lead to good result in transolecranon fracture-dislocation cases.

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