The fracture pattern was assessed using the Mayo classification  which takes into account the degree of fracture displacement and comminution as well as the stability of the elbow joint (Figure ). The surgical procedures were carried out with the patient in a supine or lateral decubitus position under general or regional anesthesia. A tourniquet was inflated and the fracture site was approached via a posterior midline skin incision. In each case, the ulnar nerve was identified with palpation but neither its release nor its transposition was primarly performed. Fracture osteosynthesis was achieved with the insertion of two parallel 1.8 mm Kirschner wires from the tip of the olecranon and a 18 gauge wire in a figure-of eight fashion. Major intraoperative goal was the perforation of the ulnar anterior cortex in an effort to increase fixation stability and to minimize pin migration. The proximal end of K-wires was bent and the cerclage wire was placed through a predrilled transverse hole in the distal fragment and under the triceps tendon. Subsequently, the cerclage wire was tightened to create interfragmentary compression. One or two-knot technique of tightening was utilized according to surgeon's preference. The entire process was done under fluoroscopic guidance. Intraoperative result was considered acceptable when less than 2 mm intra-articular gap or displacement was apparent.
To sufficiently power our analysis, we assumed that approximately 75% of surgeons surveyed used tension band wiring or plating for fixation of displaced olecranon fractures. It was calculated that 125 completed questionnaires would be required to produce a 95% confidence interval (CI) of ± 7% for the use of tension band wiring or plating, with an α level of 0.05.
AO tension-band osteosynthesis of displaced olecranon fractures
Displaced noncomminuted olecranon fractures were traditionally treated using tension band wiring, which was first described by Weber and Vasey. This method was designed with the theory that early mobilization would create tensile forces across the fracture that would be converted to compression forces and prevent nonunion, while minimizing the loss of range of motion. It has recently been shown that this principle is applicable only during active extension through a range of 30–120° of elbow flexion. However, tension band wiring remains a popular method of internal fixation of olecranon fractures. The advantages of tension band wiring compared with plate fixation include shorter surgery and lower cost. Surgeons who use this technique have shown good fracture healing and acceptable range of motion.,– However, the rates of hardware removal following tension band wiring are significant and reported to be as high as 80%.–
Displaced olecranon fracture | scholarly search
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