Gustav Cornefjord Voigt - Institutionen för kliniska vetenskaper, Malmö

Title: Behandlingsval och utfall efter olekranonfrakturer (treatment options and outcome for olecranonfractures)

Main supervisor: Daniel Wenger

Reviewers: Anna-Paulina Wiedel and David Wennergren

Abstract

Background

Olecranon fractures are common, but current treatment methods are associated with high complication and reoperation rates. This project aims to generate scientific evidence to improve treatment recommendations.

At our clinic, we have long used a surgical technique—cerclage fixation— that we believe leads to fewer complications and reoperations compared to the standard method, tension band wiring. This will be evaluated in a retrospective study (Study 1) and a prospective randomized controlled trial (Study 2).

Recently, non-operative treatment has also been proposed for displaced fractures, particularly in elderly patients. Study 3 will investigate this approach retrospectively.

Non-displaced fractures are typically managed non-operatively with expectedly good outcomes, although support for this is lacking in the literature. Study 4 aims to evaluate this with long term follow-up.

Research Questions

What are the outcomes when displaced but stable olecranon fractures are treated with cerclage fixation compared with tension band wiring?

What are the outcomes following non-operative treatment of displaced and non-displaced olecranon fractures respectively?

Preliminary Results

Study 1 found that cerclage fixation in displaced, stable fractures was associated with lower reoperation (13% vs. 27%) and complication rates (18% vs. 45%) compared with tension band wiring. Study 2 is ongoing and will further evaluate these methods in a RCT.

No results are yet available from Study 3.

Preliminary results from Study 4 show no secondary displacements and low complication rates. Four patients had mild complications, one polytrauma patient had a severe complication, and 18% reported transient stiffness after cast removal—all regained functional range of motion within 18 days. A 90- degree cast position appears to be safe, though patient-reported outcomes remain to be analyzed.

Significance

The clinically relevant differences in outcomes observed in Study 1 justify further investigation in Study 2, which aims to provide Level 1 evidence for surgical method selection. Study 3 may contribute to the body of evidence supporting non-operative treatment of selected displaced fractures, offering data to inform future guidelines and improve patient care. Study 4 may influence immobilization practices for undisplaced fractures and reduce unnecessary radiographic follow-ups.

Published studies

1. Wenger D, Cornefjord G, Rogmark C. Cerclage fixation without K-wires is associated with fewer complications and reoperations compared with tension band wiring in stable displaced olecranon fractures in elderly patients. Arch Orthop Trauma Surg. 2021.
2. Cornefjord G, Kostogiannis I, Rogmark C, Jerrhag D, Wenger D. The With Or Without Olecranon K-wire (WOW OK) Trial of tension band wire fixation versus cerclage fixation without K-wires in displaced stable olecranon fractures: study protocol for a randomized controlled trial. Trials. 2023 Aug 29;24(1):559. doi: 10.1186/s13063-023-07566-9. PMID:37641082; PMCID: PMC10464474.

A methodological description of a surgical technique used in Study 2 will be be submitted for peer review and is enclosed in manuscript form.

An abstract related to Study 4, which has been submitted for presentation at an international conference, is also enclosed.