Abstract

Suture fixation for Olecranon fractures: A Systematic Review

Author(s): Gedion.Y. Amdetsion, R.J. Macfarlane, R. Axenciuc

Background: Approximately 10% of upper limb fractures involve olecranon fractures. Traditionally, these fractures have been treated with tension band wiring or plate fixation, which often result in a high reoperation rate. To mitigate complications and reduce the need for reoperations, various techniques utilizing sutures or suture anchors have been introduced. The aim of this review is to evaluate the current best evidence on the management of olecranon fractures.

Methodology: In June 2023, relevant randomized controlled trials were systematically collected from databases including PUBMED, MEDLINE, EMBASE, and Cochrane Library. The methodological quality of the articles was assessed using risk of bias assessment tools. The study protocol was registered in the Prospero database with registration number CRD42023436800.

Results: Out of 274 initially identified records, a total of 9 studies were deemed relevant for inclusion. Among them, 7 were case series, 1 was a retrospective cohort study, and the remaining study was a case-control study. These 9 studies involved a total of 257 patients with olecranon fractures, with 49 of the fractures being chevron osteotomies. Among the patients, 101 out of 257 were male, with a mean age of 61.2 years. The follow-up periods in the included studies ranged from 6 months to 7.5 years. Outcome measures varied and included patient-rated and physician-rated measures, as well as radiological outcomes. The analysis revealed that suture fixation demonstrated a low reoperation rate and yielded satisfactory to excellent clinical and functional outcomes.

Conclusion: In summary, based on the currently available evidence, it is not possible to draw definitive conclusions regarding the clinical superiority of suture fixation for olecranon fractures. However, suture fixation does emerge as a viable alternative for treating simple displaced fractures in adults, especially when tension band wire fixation is the conventional approach. Additionally, anchor fixation utilizing Fiber Wire shows significant potential in the treatment of olecranon fractures in elderly patients. Moreover, the findings from this systematic review indicate that suture fixation may help reduce the need for reoperations.

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