Clinical Details

Clinical and radiological findings:  An unfortunate series of complications occurred due to insufficient primary fixation and lack of suture reinforcement for the triceps tendon after a proximal olecranon fracture. The initial osteosynthetic fixation failed, leading to a revision surgery involving tension band wiring (TBW) and suture augmentation with polydioxanone (PDS). However, the PDS and TBW also failed rapidly. To address this, a two-stage revision was performed, which included the removal of hardware (ROH) and exclusion of infection with a temporary antibiotic (ABx) spacer/beads. At this point, dynamic stability tests showed limited articular involvement and congruent stable range of motion (ROM), despite the distraction of the proximal fragment. In the second stage, a 4-strand, 2.0mm Fibertape triceps locking stitch was utilized. This stitch was shuttled through the fracture site into the ulnar diaphysis and emerged through two drill holes before being tied over the diaphyseal cortex to secure the fixation.