Early range of motion exercise in pediatric patients with olecranon fractures treated with tension band suture with double loops and double knots

Abstract

Background: Pediatric patients with olecranon fractures are uncommon. The tension band suture technique was introduced to reduce the burden of implant removal and other complications. However, to our knowledge, early range-of-motion exercise has not been introduced in this patient population. Double vicryl loops and knots are used to maintain the benefits of the tension band suture technique and enhance fixation tensile strength. We believe that early range-of-motion exercises could be achieved without nonunion or fixation failure. Methods: Twelve pediatric patients with olecranon fractures were treated with tension band suture with double loops and knots between 2004 and 2015. Vicryl #1 was used for wiring. Range-of-motion exercises were initiated 1 week postoperatively with a customized functional brace. Early functional outcomes were evaluated using the Mayo Elbow Performance Score 8 and 12 weeks postoperatively before implant removal. Results: Nine boys and 3 girls (average age, 10.6 years: range, 5 years 7 months–16 years 2 months) were included in the study. Initial displacement and angulation of the fractures were 5 mm (2–7) and 12° (4–25), respectively. Two cases had radial neck fractures of the ipsilateral elbow. All patients showed perfect Mayo Elbow Performance Score 8 weeks postoperatively. Pin removals were performed at 13.1 weeks. No complications, including growth arrest, were observed. Discussion/Conclusion: Tension band suture with double loops and knots, combined with early range-of-motion exercise, may be a complete alternative to tension band wiring.