A 40-year-old man falls directly on his point of the elbow. Lateral X-ray shows a transverse fracture of the olecranon separated by 5 mm with the proximal fragment pulled proximally. The preferred method of fixation is:
- A Tension band wiring with two Kirschner wires and a figure-of-eight wire loop ✓
- B Excision of the proximal fragment with triceps advancement
- C Above-elbow cast with the elbow in full extension for six weeks
- D Intramedullary screw fixation through the coronoid
Correct answer: A. Tension band wiring with two Kirschner wires and a figure-of-eight wire loop
Explanation
B displaced transverse olecranon fracture is an intra-articular injury where the triceps distracts the proximal fragment. Tension band wiring converts the distracting force of the triceps into dynamic compression across the fracture during flexion, allowing early movement. Excision with triceps advancement is considered mainly for comminuted fragments in elderly low-demand patients. Prolonged immobilisation in extension causes stiffness and does not hold a displaced intra-articular fragment reduced.
Reference: Apley and Solomon's System of Orthopaedics and Trauma, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.