title: Tension band wiring for simple olecranon fractures: evaluation of surgical technique.
abstract: In some settings, specific techniques for open reduction and internal fixation are preferred based on the eminence of a surgeon or professional organization. An emphasis on technical aspects of surgery that are not proved superior and vary substantially from surgeon to surgeon can be confusing for trainees. This study applied a numerical grading of the technical aspects of tension band wire (TBW) fixation for olecranon fracture; assessed the interobserver agreement of each criterion; and measured the correlation of the technical grading and objective and subjective long-term outcomes.
  
  
  
  Forty observers were invited to rate the technical aspects of TBW fixation of the olecranon on 26 post-operative radiographs. The interobserver reliability of the rating was measured using the intra-class correlation coefficient. The correlation between the rating and motion, Mayo elbow performance index, and disabilities of the arm, shoulder and hand score was tested with the Spearman's rank correlation test.
  
  
  
  None of the figure-of-eight TBW constructs were considered perfect according to the numerical grading: the majority of observers found three deviations per fixation. The interobserver agreement was only fair for the total number of deviations and no correlation between the number of deviations and long-term objective and subjective outcome was found.
  
  
  
  A rating of the technical aspects of TBW for olecranon fractures was unreliable and did not correlate with subjective and objective outcomes. Emphasis on specific technical aspects of fixation might be confusing for trainees and could distract them from the principles of effective treatment.
  
  
  
  Level IV diagnostic study.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Harvard Medical School and University of Amsterdam Medical School, 55 Fruit Street, Boston, MA, 02114, USA. fclaessen@mgh.harvard.edu.
authors.forename: Femke M A P
authors.initials: FMAP
authors.lastname: Claessen
authors.affiliation: Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
authors.forename: Michel P J
authors.initials: MPJ
authors.lastname: van den Bekerom
authors.affiliation: Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: C Niek
authors.initials: CN
authors.lastname: van Dijk
authors.affiliation: Trauma Unit Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Orthopaedic Sports and Traumatology, Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Gino M M J
authors.initials: GMMJ
authors.lastname: Kerkhoffs
authors.affiliation: Orthotrauma Research Center, University of Amsterdam Orthopaedic Residency Program (PGY 4), Amsterdam, The Netherlands.
authors.forename: Job N
authors.initials: JN
authors.lastname: Doornberg
mesh_terms: D000328:Adult; D000368:Aged; D001864:Bone Wires; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D056740:Olecranon Process / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Disability; Elbow trauma; Olecranon fracture; Technique pain; Tension band