Olecranon fracture fixation with tension band construct after total elbow arthroplasty

Abstract

PurposeOlecranon fractures are a known and potentially devastating complication of total elbow arthroplasty (TEA), especially if displaced with an incompetent extensor mechanism. The purpose of this study is to present a case series of olecranon fractures after TEA treated with a tension band construct and compare functional results to uncomplicated TEA patients. MethodsSix patients with displaced olecranon fractures in the setting of a prior TEA were identified and included in this retrospective case series. All patients were treated with a tension band construct. Functional scores were collected at a minimum of 1 year postoperatively, including the Mayo Elbow Performance Score (MEPS) and Single Assessment Numeric Evaluation (SANE) elbow score. Radiographs were reviewed at the time of injury and at the latest follow-up for fracture displacement, implant loosening or failure, and osseous union. A matched control group of 10 TEAs without complication was identified for comparison of functional scores. ResultsOne patient was deceased prior to the final follow-up and was not included in the functional score analysis. The average postoperative MEPS was 74 ± 18.5 and the average postoperative SANE score was 69.4 ± 13.7. Average final range of motion was 134 degrees flexion and 18 degrees extension. Three (50%) patients had radiographic signs of osseous union at an average of 3.4 months. One patient had fixation failure and subsequent triceps insufficiency and required multiple reoperations with poor functional scores at the final follow-up. No significant difference was noted in both postoperative MEPS (P = .503) and SANE (P = .142) when comparing patients with olecranon fracture to matched uncomplicated TEA patients. ConclusionTension band fixation of olecranon fractures after prior TEA is able to restore function for a difficult problem despite a 50% radiographic union rate. Patients with this complication can expect similar functional results to uncomplicated TEA patients with proper fixation.