Dogramatzis Kostas, Kitridis Dimitrios, Bekoulis Theodosios, Craig Richard
Great Western Hospital NHS FT, Swindon, UK.
1st Orthopaedic Department, George Papanikolaou Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Shoulder Elbow. 2023 Aug;15(4):424-435. doi: 10.1177/17585732221094828. Epub 2022 May 3.
Tension Band Wiring (TBW) has traditionally been the cornerstone of operative management for simple displaced olecranon fractures but its success is limited by high complication rates, mainly related to metalwork irritation and fixation failure. Over the last twelve years, a number of novel fixation methods not involving metalwork have been described in case series (suture fixation, SF and suture-anchor fixation, SAF) with promising early results. In this systematic review, the outcomes of SF and SAF techniques are presented alongside those for TBW for the treatment of closed olecranon fractures without elbow instability.
Five databases (Medline, Scholar, Scopus, Prospero and Cochrane) were searched for clinical studies involving TBW/SF/SAF for closed Mayo 1A/1B/2A/2B olecranon fractures from January 2010 onwards. Primary outcomes included overall complication and reoperation rates, as well as the rate of each specific complication. Elbow range of movement, surgeon and patient-reported outcome measures were defined as secondary outcomes.
Eighteen studies were included, nine of which involved SF/SAF (99 patients) and nine TBW (382 patients). SF/SAF techniques were associated with lower rates of fracture/implant displacement (2% versus 9.7%, = 0.01), implant irritation (1% versus 30.1%, < 0.001) and overall complications (8% versus 46.1%, < 0.001) when compared to TBW. Reoperation rates were lower for SF/SAF (3% versus 37.2%, < 0.001). Total flexion/extension arc achieved was similar (130.16 ± 2.11 versus 129.45 ± 0.93 degrees). On average, patients regained a functional arc of flexion (135.21 ± 4.81 TBW versus 131.32 ± 12.99 SF/SAF) and extension (1.16 ± 7.54 SF/SAF versus 5.76 ± 7.98 TBW).
Current evidence suggests that SF/SAF of simple olecranon fractures is a safe and effective alternative to the current gold standard TBW fixation, with preliminary evidence suggestive of lower complication and reoperation rates. Firm conclusions of equivalence or superiority are not possible based on the current poor quality of literature available. Until the outcomes of high-quality prospective studies are available, patients should be carefully counselled that suture methods remain novel and outcomes should be regularly audited.
张力带钢丝固定术（TBW）一直是单纯移位型鹰嘴骨折手术治疗的基石，但其成功率受到高并发症发生率的限制，主要与金属植入物刺激和固定失败有关。在过去的十二年中，一些不涉及金属植入物的新型固定方法已在病例系列中得到描述（缝线固定，SF和缝线锚钉固定，SAF），早期结果令人鼓舞。在本系统评价中，展示了SF和SAF技术以及TBW治疗无肘关节不稳的闭合性鹰嘴骨折的结果。
检索五个数据库（Medline、Scholar、Scopus、Prospero和Cochrane），查找自2010年1月起涉及TBW/SF/SAF治疗闭合性梅奥1A/1B/2A/2B型鹰嘴骨折的临床研究。主要结局包括总体并发症和再次手术率，以及每种特定并发症的发生率。肘关节活动范围、外科医生和患者报告的结局指标被定义为次要结局。
纳入18项研究，其中9项涉及SF/SAF（99例患者），9项涉及TBW（382例患者）。与TBW相比，SF/SAF技术的骨折/植入物移位率（2%对9.7%，P = 0.01）、植入物刺激率（1%对30.1%，P < 0.001）和总体并发症发生率（8%对46.1%，P < 0.001）较低。SF/SAF的再次手术率较低（3%对37.2%，P < 0.001）。实现的总屈伸弧度相似（130.16±2.11度对129.45±0.93度）。平均而言，患者恢复了功能性屈曲弧度（TBW为135.21±4.81度，SF/SAF为131.32±
12.99度）和伸展弧度（SF/SAF为1.16±7.54度，TBW为5.76±7.98度）。
目前的证据表明，单纯鹰嘴骨折的SF/SAF是当前金标准TBW固定的一种安全有效的替代方法，初步证据表明并发症和再次手术率较低。基于目前现有文献质量较差，无法得出等效或优越性的确切结论。在获得高质量前瞻性研究的结果之前，应仔细向患者咨询，缝线方法仍然是新方法，应定期审核结果。
