Tension-band wiring for olecranon fractures: Analysis of risk factors for failure

Thirty-seven consecutive olecranon fractures treated with tension-band wiring were evaluated at a mean follow-up of 4 years. There was no or mild pain in 33 cases, mean elbow extension was 7°, and mean elbow flexion was 131°. According to the Mayo Elbow Performance Score, the results were graded as good or excellent in 32 cases (86%). Most patients had mild residual upper extremity disability (mean Disabilities of the Arm, Shoulder and Hand score, 18 points). In 10 patients, degenerative changes developed. Arthritic changes were significantly associated with elbow instability (P = .014) and length of follow-up (P = .031) and were more common in the presence of associated radial head or coronoid fractures (P = .06). Hardware removal was required in 17 cases. Tension-band wiring provides satisfactory results in a high percentage of olecranon fractures. However, the outcome may be compromised in the presence of elbow instability and associated fractures of the radial head and coronoid.