Fractures Of The Olecranon – Cerclage Compression Wiring vs Plating

Abstract

Background: There is still no generally accepted osteosynthesis of the displaced fractures of the olecranon – compression cerclage wiring (CCW) or plate. Some studies find the lower risk for failure and for symptomatic hardware removal as advantages of the plate, others – the lower rate of infections as advantages of the CCW. Additionally, most studies report similar functional results.

Aim: To compare the clinical results, as well as the rates of non-anatomic reduction and implant failure after osteosynthesis of olecranon fractures by CCW vs plate.

Materials and methods: For a period of 5 years (2020-2024), 111 patients with olecranon fractures were operated in First clinic of orthopaedic trauma, “N. I. Pirogov” Emergency Hospital. In all cases open reduction was performed, with plate osteosynthesis in 71 patients and tension band wiring in 40. Of them, 94 patients (63 with plates and 31 with CCW) were followed until fracture union.

Results: The patients with CCW showed significantly higher rates of non-anatomic reduction (step-off >2 mm or diastasis >3 mm) – 9/40 (22.5%) vs 5/71 (7.04%) for the patients with plates (p=0.002427). The rate of implant failure was similar – 2/31 (6.7%) for the CCW and 3/63 (4.7%) for the plate osteosynthesis (p=0.345). Reoperations (mostly hardware removals) were done in 13/63 (20.3%) of the patients with plates and in 11/31 (35.4%) of the patients with CCW (p=0.045).

Discussion: This study shows significantly higher risk for non-anatomic reduction in patients with CCW. This can be attributed to the use of the plate as a stable reduction template.

Conclusion: The higher rate of non-anatomic reduction in patients with CWW, found in our study, is a strong argument in favor of the plate osteosynthesis in patients with fractures of the olecranon, especially in cases with comminution and in elderly patients.