A novel method for treating elbow fractures developed at the University of Arizona Department of Orthopaedic Surgery has become part of clinical practice since it was presented at the Orthopedic Research Society annual meeting in 2010 and published in the journal Orthopedic Trauma in 2012.

At the time of the study, suture augmentation for repairing fractures of the humerus and patella – in which a strong, tendon-like insertion is attached to a small, bony fragment – was well established.

The technique had not been applied to olecranon fractures, which account for roughly one in 10 elbow fractures. Researchers at the University of Arizona devised a way to apply that same concept to olecranon fractures in such a way that a portion of the triceps tension on the olecranon is transferred to the locking plate.

To evaluate the innovation, they gave six matched pairs of cadaveric elbows a simulated proximal one-third fracture of the olecranon with a transverse cut to the bone.

Researchers then performed identical plate fixations on each elbow using olecranon locking plates. One elbow of each pair (alternating left and right) was then assigned to the experimental condition of augmentation.

That augmentation involved attaching plate to tricep muscle with sutures attached via a modified Krackow stitch.

Finally, the team tested the joints to failure using a hydraulic testing machine. As predicted, the technique helped overcome a common challenge in using fixed plates in olecranon repair: the ability to maintain fixation with smaller olecranon fragments.

The study demonstrated that suture augmentation can take advantage of ‘‘purchase’’ into the triceps tendon as a way to off-load the proximal fixation and thereby improve pullout strength. Suture augmentation consistently improved the single load-to-failure strength, with a median increase of 48%.          

Although not indicated for every fracture, the procedure is especially attractive given its low cost and technical ease, and it has been adopted into clinical practice in the years since its initial demonstration.      

Journal Citation

Wild JR, Askam BM, Margolis DS, Geffre CP, Krupinski EA, Truchan LM. Biomechanical evaluation of suture-augmented locking plate fixation for proximal third fractures of the olecranon. J Orthop Trauma. 2012 Sep;26(9):533-8. doi: 10.1097/BOT.0b013e318239273c. PMID: 22430521.