Efficacy comparison of Kirschner-wire tension band and anchor loop plate in treatment of olecranon fracture

Abstract

Objective: This study aimed to introduce a new surgical method for the fixation of olecranon fractures, and to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band and anchor loop plate (ALP) in the treatment of olecranon fractures. Methods: A finite element model was established to analyze the mechanical properties of Kirschner wire tension and anchor loop plate fixation for olecranon fracture. The clinical data of 53 patients with olecranon fractures admitted to our hospital from March 2016 to October 2021 were retrospectively analyzed. Among them, 22 cases were fixed with an anchor loop plate (ALP group), and 31 patients were fixed with the Kirschner wire tension band technique. By reviewing the medical records and follow-up results, the final elbow mobility, secondary surgery, postoperative complications and elbow function recovery Mayo score and DASH score were compared between the two groups. Results: The biomechanical analysis of the finite element model showed that under the load of 120 N, the maximum displacement of the Kirschner wire group was 1.09 times that of the ALP group, the maximum stress of the Kirschner wire group was 1.33 times that of the ALP group, and the maximum stress of the olecranon proximal bone of the Kirschner wire group was 2.17 times that of the ALP group. Under the load of 200 N, the maximum displacement of the Kirschner wire group was 1.19 times that of the ALP group. The overall maximum stress of the Kirschner wire group was 1.59 times that of the ALP group, and the maximum stress of the proximal olecranon bone of the Kirschner wire group was 1.99 times that of the ALP group. The average follow-up time of the Kirschner wire and anchor loop plate groups was similar (p > 0.05). The average age of the two groups was identical (p > 0.05). The final elbow mobility in the anchor loop plate group was significantly greater than in the Kirschner wire group (p < 0.05). The Mayo score of the anchor loop plate group was substantially higher than that of the Kirschner wire group at 3 and 12 months after operation (p < 0.05), and the DASH score was significantly lower than that of the Kirschner wire group (p < 0.05). Postoperative complications in the two groups: 1 case (4.5%) in the anchor loop plate group had difficulties with internal fixation stimulation, and no infection occurred; in the Kirschner wire group, 5 cases (16.1%) had complications of internal fixation stimulation, and 1 patient (3.2%) had an infection. Conclusion: The model of olecranon fracture fixed by anchor loop plate and Kirschner wire tension technique was tested under 120 and 200 N tension, and no damage was found, indicating that the newly designed anchor loop plate was safe in mechanical structure. The biomechanical stability of the anchor plate technique is more stable, so it is not easy to have postoperative complications such as fracture block cutting and internal fixation failure. And the secondary operation rate and elbow function have better results. This technique is an effective method for the treatment of olecranon fractures.

Keywords: anchor loop plate; finite element analysis; internal fixation; olecranon fracture; tension band.