Advantages of expulsion-proof pins in the treatment of olecranon fractures with tension band wiring: Comparison with a control group

Introduction: Tension band wiring is considered the standard treatment for transverse olecranon fractures. Its main complications are pin migration and discomfort caused by the hardware. We have designed and used "expulsion-proof" pins (EPP) that are shaped to prevent migration and reduce discomfort. This study compared the complication rate between our device and Kirschner pins (controls). Hypothesis: We hypothesised that EPP would have lower migration rates and fewer complications than standard Kirschner pins. Materials and methods: This retrospective, single-center, multi-operator, observational, study examined data from January 1996 to December 2014. The primary outcome was the occurrence of pin migration. Secondary outcomes were the occurrence of one or more additional complications and the hardware removal rate. Results: The study enrolled 101 patients: 53 (52.4%) with expulsion-proof pins and 48 (47.6%) controls. The mean follow-up was 240.6 days in the EPP group and 268.9 days in the control group. No cases of migration (0%) were found in the EPP group versus 21 (43.7%) cases in the controls (p < 0.05). One or more complications occurred in 18 (33.9%) patients in the EPP group versus 46 (95.8%) controls (p < 0.05). There was material discomfort in 13 (24.5%) cases and 1 (1.9%) case of secondary displacement in the EPP group, compared with 38 (79.2%) and 7 (14.6%) cases, respectively, in the controls (p < 0.05). The rate of delayed consolidation was statistically identical in the two groups (p = 0.103). The hardware was removed in 13 (24.5%) cases in the EPP group compared with 36 (75%) controls (p < 0.05). Conclusion: EPPs are useful for management of olecranon fractures treated via TBW: the pins do not migrate and can reduce complications, discomfort, secondary displacement, and the hardware removal rate. (C) 2019 Elsevier Masson SAS. All rights reserved.