The biomechanical strength of olecranon fixation constructs: a systematic review and meta-regression


  • Brenden Cutter Valley Consortium for Medical Education, Modesto, California, USA
  • Shayne R. Kelly Valley Consortium for Medical Education, Modesto, California, USA
  • Charles R. Beckett Valley Consortium for Medical Education, Modesto, California, USA
  • Eric G. Huish Valley Consortium for Medical Education, Modesto, California, USA



Olecranon fracture, Olecranon fixation, Biomechanical, Cadaveric


Olecranon fractures are often operative when displaced over 2 mm, but the most stable fixation construct is debated. The purpose of this study was to provide an overview of biomechanical properties of the most commonly used surgical fixations of olecranon fractures. This systematic review included 13 biomechanical studies comparing displacement during cyclic loading of olecranon fractures fixated with either tension band wiring (TBW), intramedullary screw, or plate fixation. In regard to overall gapping, plates displayed (and screws trended towards) increased stability versus TBW. However, there was no difference between the constructs in gapping at the articular surface. Plating displayed increased stability along the posterior surface. No construct allowed gapping over 2 mm, suggesting safe early post-operative motion with any of the techniques.


Rouleau DM, Sandman E, van Riet R, Galatz LM. Management of fractures of the proximal ulna. J Am Acad Orthop Surg. 2013;21(3):149-60.

Ring D, Jupiter JB, Gulotta L. Atrophic nonunions of the proximal ulna. Clin Orthop Relat Res. 2003;(409):268-74.

Weber BG, Vasey H. Osteosynthesis in olecranon fractures. Z Unfallmed Berufskr. 1963;56:90-6.

Chalidis BE, Sachinis NC, Samoladas EP, Dimitriou CG, Pournaras JD. Is tension band wiring technique the "gold standard" for the treatment of olecranon fractures? A long term functional outcome study. J Orthop Surg Res. 2008;3:9.

Rowland SA, Burkhart SS. Tension band wiring of olecranon fractures. A modification of the AO technique. Clin Orthop Relat Res. 1992;(277):238-42.

Fyfe IS, Mossad MM, Holdsworth BJ. Methods of fixation of olecranon fractures. An experimental mechanical study. J Bone Joint Surg Br. 1985;67(3):367-72.

Hutchinson DT, Horwitz DS, Ha G, Thomas CW, Bachus KN. Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am. 2003;85(5):831-7.

Nowak TE, Burkhart KJ, Mueller LP, Mattyasovszky SG, Andres T, Sternstein W, Rommens PM. New intramedullary locking nail for olecranon fracture fixation--an in vitro biomechanical comparison with tension band wiring. J Trauma. 2010;69(5):E56-61.

Gill JR, Vermuyten L, Schenk SA, Ong JCY, Schenk W. Olecranon fixation with two bicortical screws. Bone Jt Open. 2020;2;1(7):376-82.

Kia C, Dukas AG, Marshall ST. Biomechanical Comparison of Olecranon Sled Versus Intramedullary Screw Tension Banding for Olecranon Osteotomies. Orthop J Sports Med. 2018;6(12):2325967118816075.

Koziarz A, Woolnough T, Oitment C, Nath S, Johal H. Surgical Management for Olecranon Fractures in Adults: A Systematic Review and Meta-analysis. Orthopedics. 2019;42(2):75-82.

Meldrum A, Kwong C, Archibold K, Cinats D, Schneider P. Olecranon Osteotomy Implant Removal Rates and Associated Complications. J Orthop Trauma. 2021;35(5):265-70.

Fusaro I, Orsini S, Stignani Kantar S, et al. Elbow rehabilitation in traumatic pathology. Musculoskelet Surg. 2014;98:95-102.

Prayson MJ, Williams JL, Marshall MP, Scilaris TA, Lingenfelter EJ. Biomechanical comparison of fixation methods in transverse olecranon fractures: a cadaveric study. J Orthop Trauma. 1997;11(8):565-72.

Carofino BC, Santangelo SA, Kabadi M, Mazzocca AD, Browner BD. Olecranon fractures repaired with FiberWire or metal wire tension banding: a biomechanical comparison. Arthroscopy. 2007;23(9):964-70.

Lalliss SJ, Branstetter JG. The use of three types of suture and stainless steel wire tension banding for the fixation of simulated olecranon fractures: a comparison study in cadaver elbows. J Bone Joint Surg Br. 2010;92(2):315-9.

Midtgaard KS, Søreide E, Brattgjerd JE, Moatshe G, Madsen JE, Flugsrud GB. Biomechanical comparison of tension band wiring and plate fixation with locking screws in transverse olecranon fractures. J Shoulder Elbow Surg. 2020;29(6):1242-8.

Gruszka D, Arand C, Nowak T, Dietz SO, Wagner D, Rommens P. Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study. Int Orthop. 2015;39(5):955-60.

Gruszka D, Arand C, Greenfield J. Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones. Arch Orthop Trauma Surg. 2017;137(12):1651-8.

Petraco DM, Koval KJ, Kummer FJ, Zuckerman JD. Fixation stability of olecranon osteotomies. Clin Orthop Relat Res. 1996;(333):181-5.

Lalonde JA Jr, Rabalais RD, Mansour A. New tension band material for fixation of transverse olecranon fractures: a biomechanical study. Orthopedics. 2005;28(10):1191-4.

Sadri H, Stern R, Singh M, Linke B, Hoffmeyer P, Schwieger K. Transverse fractures of the olecranon: a biomechanical comparison of three fixation techniques. Arch Orthop Trauma Surg. 2011;131(1):131-8.

Hammond J, Ruland R, Hogan C, Rose D, Belkoff S. Biomechanical analysis of a transverse olecranon fracture model using tension band wiring. J Hand Surg Am. 2012;37(12):2506-11.

Boden AL, Daly CA, Dalwadi PP. Biomechanical Evaluation of Standard Versus Extended Proximal Fixation Olecranon Plates for Fixation of Olecranon Fractures. Hand (N Y). 2019;14(4):554-9.

Hackl M, Mayer K, Weber M. Plate Osteosynthesis of Proximal Ulna Fractures-A Biomechanical Micromotion Analysis. J Hand Surg Am. 2017;42(10):834.e1-834.e7.

Wallace BC, Small K, Brodley CE. Deploying an interactive machine learning system in an evidence-based practice center: abstrackr. In: Proceedings of the ACM International Health Informatics Symposium (IHI). New York: Association for Computing Machinery. 2012;819-24.

Nowak TE, Mueller LP, Burkhart KJ, Sternstein W, Reuter M, Rommens PM. Dynamic biomechanical analysis of different olecranon fracture fixation devices--tension band wiring versus two intramedullary nail systems: an in-vitro cadaveric study. Clin Biomech (Bristol, Avon). 2007;22(6):658-64.

Nowak TE, Mueller LP, Sternstein W. Dynamische Analyse von Osteosynthesen am Olecranon: ein in-vitro Vergleich zweier Osteosynthesesysteme [Dynamic analysis of olecranon osteosyntheses--an in vitro comparison of two osteosynthesis systems]. Biomed Tech (Berl). 2008;53(2):86-90.

Nowak TE, Burkhart KJ, Andres T. Locking-plate osteosynthesis versus intramedullary nailing for fixation of olecranon fractures: a biomechanical study. Int Orthop. 2013;37(5):899-903.

Wilke J, Krause F, Niederer D. Appraising the methodological quality of cadaveric studies: validation of the QUACS scale. J Anat. 2015;226(5):440-6.

Heim U, Pfeiffer KM. Internal fixation of small fractures: technique recommended by the AO-ASIF Group. 3rd ed. New York, NY: Springer. 1988;112.

Hahn A, O'Hara NN, Koh K, Zhang LQ, O'Toole RV, Andrew Eglseder W. Is intramedullary screw fixation biomechanically superior to locking plate fixation and/or tension band wiring in transverse olecranon fractures? A cadaveric biomechanical comparison study. Injury. 2020;51(4):850-5.

Buijze GA, Blankevoort L, Tuijthof GJ, Sierevelt IN, Kloen P. Biomechanical evaluation of fixation of comminuted olecranon fractures: one-third tubular versus locking compression plating. Arch Orthop Trauma Surg. 2010;130(4):459-64.






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