Dieterich J, MD, Kummer, F J, MD, Ceder, L, MD

Acta Orthopaedica, 2006, June. Volume 77 Issue 3, Pages 440-444

Background: Tension band wiring is the most common surgical procedure for fixation of fractures of the olecranon, but symptomatic hardware prominence and migration of K-wires can cause a high re-operation rate. The olecranon sled has been designed to minimize some of these problems.

Material and Methods: Simulated olecranon fractures were created in 6 matched pairs of cadaver arms. Each pair was fixed with tension band wiring used on the one arm and the olecranon sled being used on the other. Mechanical testing was done with the humerus rigidly fixed in a vertical position while the forarm was held at 1 of 3 angles of elbow fixation, 45*, 90* and 135*, respectively. For each angle, the the triceps and the brachialis muscles were sequentially loaded with 5 kg (50 N) for 20 cycles and the amount of fracture displacement measured.

Results: Loading of the brachialis muscle produced no increase in the fracture gap for either of the two fixation techniques. Howeer, an increase in the fracture gap of up to 0.23 mm was found after cyclic loading of the triceps muscle was not significantly different between the two techniques.

Interpretation: The olecranon sled appears to provide as stable fixation as tension band wiring for olecranon fractures.

Iorio T, Wong J, Patterson JD, Rekant M

Techniques in Hand and Upper Extremity Surgery; 2013, Sep. Volume 17, Number 3, Pages 151-157

Abstract: A posterior approach to the elbow utilizing an olecranon osteotomy has been shown to provide excellent visualization of the distal humerus articular surface. However, many bony stabilization and fixation methods for the olecranon osteotomy are usually prominent, frequently sympotomatic, and often require a second operation for removal. This paper evaluates the use of an innovative device, the olecranon sled, in fixation of olecranon osteotomies for exposure of intra-articular distal humerus fractures and provides follow-up results. A retrospective review of all patients with intra-aricular distal humerus fracture treated through an olecranon osteotomy approach and

Lovy A, MD, MS, Levy I, BS, Keswani A, BA, Rubin T, MD, Hausman M, MD

Journal of Shoulder and Elbow Surgery, 27(3), 393–397. Mar 2018

Background: Tension-band wiring is largely considered the gold standard for fixation of displaced olecranon fractures despite high rates of hardware complications. The purpose of this study was to report the outcomes of displaced olecranon fractures treated wih the Olecranon Sled.

Methods: We retrospectively reviewed all displaced olecranon fractures from 2011-2015 treated with the Olecranon Sled. Inclusion was limited to functionally independent patients with Mayo type II freactures and minimum 12-month follow up. We assessed clinical outcomes including range of motion; Disabilties of the Arm, Shoulder and Hand Score; and Mayo Elbow performance Score.

Results: Twenty-two patients with a mean follow-up period of 31.8 months (range, 12-71 months) were included inthe study. All patients indicated satisfactory outcomes. The mean Mayo Elbow Performance Score was 95.5 (range, 70-100), and the mean Disabilities of the Arm, Shoulder and Hand score was 3.1 (range, 0 -18.3). The mean total arc of elbow flexion was 145* (range, 134* – 158*), and the mean total arc of forearm roation was 175* (range, 160* – 180*). There were no hardware-related complications. The overall complications rate was 4.5% (1 of 22) as significant heterotopic ossification developed in 1 patients, requiring contracture release.

Conclusion: The Olecranon Sled is a reliable and well-tolerated implant for the treatment of olecranon fractures. This device results in excellent functional outcomes and may obviate hardware removal.

Level of evidence: Level IV; Case Series: Treatment Study

Mazzocca AD, MD MS, Browner BD, MD MHCM, Obopilwe E, MS, Voss A, MD

Orthopaedic Journal of Sports Medicine, 6(12), 1-7, Dec 2018

Background: Olecranon osteotomies are frequently performed to gain access to the distal humeral articular surface. Repair of the osteotomy or fixation of a simple 2-part olecranon fracture with traditioinal tension band construct is often plagued by complication. Proximal migration and irritation attributed to hardware are common complications of the standard construct of an intramedullary screw with tension band and are causes for reoperation.

Purpose: To compare the biomechanical performance, time of implant, and prominence of an intramedullary screw and tension band construct with that of a newer low-profile continous loop tension band (Olecranon Sled) construct in an olecranon osteotomy model.

Study Design: Controlled laboratory study.

Methods: Chevron osteotomies were created in 6 matched pairs of frozen-fresh human elbows (mean age, 66 +/- 16 years). Each matched pair was then randoly divided into 1 or 2 groups; fixation with a screw and tension band construct of the Olecranon Sled. Bone mineral density, implant prominence, and time for implantation were recorded. Following olecranon fixation, each specimen underwent cyclic loading of 0 to 10 N for 100 cycles (to simulate unresisted active range of motion) and then 0 to 500 N for 500 cycles (to simulate pushing up from a chair) to measure for any displacement at the osteotomy site. The constructs were then loaded to failure and compared.

Results: No differences were found in bone mineral desnsity between the 2 groups (P=0.290). When measured from the tip of the olecranon, the continous loop tension hand had a medial prominense of only 3.57 +/- 0.4 mm, as opposed to the intramedullary screw fixation of 7.288 +/- 0.762 mm (p = 0.027). Total time of implantation, including osteotomy preparation, was a mean 155 seconds shorter with the Olecranon Sled versus the traditional tension band (P < 0.05). Because of the fracture of 1 specimen during cyclic loading, it and its matched counter part were excluded, and only 5 matched pairs were analyzed for displacement and load to failure. There were no significant differences between groups in load to failure or displacemnt during cyclic loading (P > 0.05).
Conclusion: The Olecranon Sled device was found to have no difference in biomechanical strength from that of the standard intramedullary screw with tension band construct. The Olecranon Sled was also found to be signficantly less prominent while being faster to implant than the intramedullary screw.
Clinical Relevance: Evaluating an alternative option to the standard tension band constrct is important for patients with olecranon fractures or osteotomies, as standard techniques have been fraught with hardware issues and need revision surgery.