Modified Suture Tension Band Technique for Repair of Simple Olecranon Fractures

Operative fixation of simple displaced olecranon fractures is traditionally performed using tension band wiring or plate fixation, both of which are associated with symptomatic hardware and secondary removal procedures. Suture only constructs have been introduced to mitigate these complications, but concerns remain regarding construct stability and early fracture gapping. This study describes a modified suture tension band (MSTB) technique supplemented with a headless compression screw (HCS) to improve compression and stability. The MSTB technique combines a dual suture tension band construct with a metaphyseal HCS. After fracture reduction, the HCS guidewire is placed centrally across the fracture for provisional fixation, followed by the creation of two distal ulnar bone tunnels for tension band sutures. The sutures are passed from the bone tunnels through the tricep tendon in a box type stitch, and a figure-of-8 type stitch.  The sutures are provisionally tensioned and tied.  The HCS is then inserted to provide interfragmentary compression. The sutures are then re-tensioned and secured, burying the knots under the anconeus. The MSTB technique enhances the stability of suture-based fixation by combining the low-profile advantages of suture constructs with the compressive strength of a headless screw.  We believe this modification reduces the risk of early fracture gapping and nonunion while preserving the benefits of avoiding prominent hardware. The technique is particularly well suited for olecranon fractures with small proximal fragments and poor bone quality and may represent a reliable alternative to traditional fixation methods.