Review Question - QID 1243

The most common complication of an olecranon fracture treated with tension band wiring is symptomatic implants. This is largely related to the subcutaneous nature of the olecranon.

Macko and Szabo encountered a high incidence of complications related to the technique of tension-band wire fixation of displaced fractures of the olecranon in a five-year retrospective study of twenty patients. They reported that the most frequent complication of this construct is symptomatic prominence of the hardware which is usually due to improper seating at the time of surgery. Other complications reported include loss of fixation, skin breakdown, and infection.

Hume and Wiss reported on 41 patients randomized to tension band wiring and plate fixation. They note that there was no difference in regards to elbow motion postoperatively, but plating required more operative time. Plating of these fractures resulted in a significantly increased rate of good clinical and radiographic results.

Figure A shows an AP and lateral radiograph of an olecranon fracture treated with tension-band wiring.

Incorrect Answers:
Answer 1: This is a possibility with overpenetration of the wires through the anterior ulnar cortex, but not a common finding.
Answer 2: This is not a common finding with this treatment method.
Answer 3: Although implant failure is a possibility with this technique, this is not the most common complication.
Answer 5: Avascular necrosis of the proximal ulna is not a common complication of this injury or treatment method.