Ronald Navarro - Southern California Permanente Medical Group,Kaiser Permanente, South Bay Medical Center, Harbor City, CA, USA
Albert Hsu - Southern California Permanente Medical Group, Kaiser Permanente, Downey Medical Center, Downey, California, USA
Jun Wu - Division of Biostatistics, Kaiser Permanente Department of Research & Evaluation, Pasadena, California, USA
Christen Mellano - Coastline Orthopaedic Associates, Fountain Valley, California, USA
Dennis Sievers - Kaiser Permanente School of Medicine, Pasadena, California, USA
David Alfaro - Kaiser Permanente School of Medicine, Pasadena, California, USA
Abtin Foroohar - Upper Extremity Surgeon, Kaiser Permanente, South Bay Medical Center, Harbor City, California, USA

wiring (TBW) versus plate osteosynthesis (POS) in the treatment of olecranon fractures.Methods: We performed a retrospective cohort study of operatively treated adult olecranon fractures from an integratedhealthcare system by multiple surgeons from January ۲۰۰۸ to December ۲۰۱۱. Patients were divided into two cohorts:fractures fixed using the tension band technique and fractures fixed using plate osteosynthesis. The study was limitedto the Orthopedic Trauma Association classification of olecranon fracture type ۲۱-B۱, with subtypes ۱-۳. Outcomemeasures were loss of fracture fixation requiring revision, postoperative infection, stiffness requiring surgery, andsymptomatic hardware removal (HWR). Univariate and multivariable logistic regressions were performed to test theassociations between the type of internal fixation and outcomes.Results: A total of ۳۲۱ olecranon fractures were included (median age: ۶۱ years old, ۵۷ % female); ۱۵۳ participantswere treated with TBW, and ۱۶۸ patients with POS. There was one failure in the TBW group and two in the POS group(P=۰.۶۲). There were no significant differences in the infection rates (TBW ۵%, POS ۹%, P=۰.۲۰) and no reoperationsfor stiffness. The HWR occurred significantly more often in TBW (۲۹%) than in POS (۱۴%) (OR=۰.۳۹, P=۰.۰۰۱). Theassociation between POS and decreased HWR remained highly significant (OR=۰.۴۰, P=۰.۰۰۳) after adjusting forclinical variables.Conclusion: In this large study comparing POS and TBW for ۲۱-B۱ olecranon fractures, no difference in fixationfailure, infection, or postoperative stiffness was noted. A significantly greater risk of symptomatic hardware occurredin TBW. These findings may assist surgeons and patients in considering the risks and benefits of TBW and POSas treatment options for displaced olecranon fractures.Level of evidence: III

fixation failure, Hardware Removal, Infection, multifragmentary, skin breakdown