K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures.
BACKGROUND
Tension-band wiring (TBW) has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to examine the effect of K-wire position on instability of the K-wires in relation to local complications and radiological and clinical long-term outcome.


METHODS
We reviewed the early follow-up of 59 patients (mean age, 60 years) who underwent TBW osteosynthesis for displaced olecranon fractures. Follow-up information was available from medical records and radiographs. The main outcome measurements were proximal migration of the wires, gap, step, range of motion, and complications. Long-term follow-up included 21 patients (mean age, 58 years). Follow-up was available from a clinical visit and a radiograph. Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm Shoulder and Hand (DASH), EuroQol-5D (EQ-5D), and Broberg and Morrey osteoarthritis scores were obtained.


RESULTS
Seventy-eight percent of the patients treated with intramedullary K-wires were found to have instability of K-wires, compared to 36% in the patients treated with transcortical K-wires. Patients with instability of the K-wires tend to develop osteoarthritis more often. There is a better functional outcome in patients where the osteosynthetic material is removed.


CONCLUSIONS
Instability of K-wires after TBW is more common after intramedullary placement of the wires resulting in proximal migration of the K-wires and gap appearance. There was a tendency of more osteoarthritis in the group of patients where instability of K-wires was identified. We would recommend the use of transcortical placed wires, as well as to have a low threshold in removing the implants.
Department of Orthopaedics and Traumatology, Flinders University Medical Centre, Adelaide, Australia.
Sabine C
SC
van der Linden
Albert
A
van Kampen
Ruurd L
RL
Jaarsma
D000328:Adult; D000368:Aged; D001864:Bone Wires; D015331:Cohort Studies; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007593:Joint Instability / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D056740:Olecranon Process / Q000293:injuries* / Q000601:surgery; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000092464:Elbow Injuries