Comminuted Olecranon Fractures (Mayo IIB): Is Dynamic Tension Band Wiring Enough?

Objectives:To compare the efficacy and outcomes of dynamic tension band wiring (TBW) and plate and screw (PS) fixation of comminuted (Mayo Type IIB) olecranon fractures.Design:Retrospective cohort.Setting:Academic medical center.Patients/Participants:Forty-one patients with Mayo type IIB (OTA/AO 2U1C) olecranon fractures were involved in the study.Intervention:Patients with tensile Mayo type IIB olecranon fractures between August 2012 and November 2020 treated by a single surgeon with either TBW or PS fixation were reviewed for demographics, radiographic/surgical details, and clinical/functional outcomes. Descriptive fracture data included proximal olecranon fragment size and the presence of joint impaction at surgery.Main Outcome Measurements:The main outcome measurements were Mayo Elbow Performance Score, elbow range of motion, patient-reported pain, and complications.Results:The mean follow-up was 38 months. Fractures healed for all patients in both groups. No differences in clinical outcomes, functional outcomes, elbow range of motion, or complications were seen between fixation groups. There was no difference in proximal fragment size between the 2 groups. Fractures with articular impaction requiring elevation and grafting demonstrated no difference in clinical or functional outcomes when compared with those that did not have any impaction. However, patients with impacted articular fractures treated with TBW had a higher rate of implant removal (25% vs. 0%, P = 0.05) when compared with those treated with PS.Conclusions:Comminuted Mayo IIB olecranon fractures are amenable to TBW or plate construct, with similar clinical and functional outcomes. The presence of articular impaction is associated with a greater need for implant removal.