Article
Use of Kirschner Wires With Eyelets for Tension Band Wiring of Olecranon Fractures
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Published: | February 6, 2020 |
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Objectives/Interrogation: Tension band wiring is a widely accepted fixation technique for displaced olecranon fractures. It has a well-established biomechanical basis and has been reported to provide good outcomes in several long-term studies. However, the technique may be insufficient in the presence of comminution, instability, or substantial extension into the coronoid process. Despite the efficacy of this technique, prominence of the Kirschner wire at the insertion site is a commonly reported problem. In the majority of cases, this prominence is caused by proximal pin migration and can result in pain, skin breakdown before pin removal, secondary displacement, or subsequent malunion or nonunion. Although an alternative technique involving running the distal ends of Kirschner wires through the anterior ulnar cortex has been proposed to reduce the incidence of pin migration, other complications such as restrictions of forearm rotation and anterior interosseous nerve injury have been reported regarding this modification. Therefore, we proposed that a more effective approach was required to prevent pin migration and other complications such as restriction of forearm rotation or neurovascular injury. Accordingly, we have used a modified Kirschner wire, which features an eyelet near the trailing end to prevent pin migration.
Methods: The authors retrospectively reviewed 44 patients treated for an isolated, displaced olecranon fracture and checked range of motion, postoperative pain, complications, and incidence of hardware removal. The mean follow-up period was 41 months (range, 26 -73 mo).
Results and Conclusions: All fractures united, and anatomical reduction was achieved in all cases at final follow-up. Mean elbow flexion was 135° (range, 115° to 140°), and mean elbow extension was 4° (range, 0° to 15°). No pin migration, restriction of forearm rotation, or neurovascular injury occurred. Hardware removal was performed in 8 cases (18%). Compared to previous results with conventional Kirschner wires, no meaningful improvement in postoperative pain level or in the rate of hardware removal was observed.
Tension band wiring using the pin studied produced excellent clinical and radiologic outcomes for the treatment of isolated, displaced Mayo type IIA and some type IIB olecranon fractures. The pin was effective in preventing the backing out of Kirschner wires and avoiding the complications associated with anterior cortical engagement of Kirschner wires, such as neurovascular injury or restriction of forearm rotation.