الفهرس 
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Abstract
The aim of the current study was to compare the results of displaced olecranon fracture fixation by tension band wiring versus pre-contoured hook plate.
The study was done on twenty patients admitted to El Hadara University Hospital from april 2012 to april 2013.
All patients on admission after there complete survey for exclusion of other associated pathology were assessed by complete history, clinical examination and radiological study.
The fractures were classified according to Mayo’s classification focused mainly on type II (stable simple and stable comminuted fractures) and type III (unstable simple and unstable comminuted fractures).
Fracture fixation was done through direct posterior approach with the patient is laterally positioned, after fracture reduction for tension band wiring A small two stab incisiones are done in the triceps aponeurosis.Two kirschner wires are applied passing toward the medullary canal of the ulna or the anterior cortex distal to coronoid process.A 2.5mm transverse hole is drilled in the posterior cortex of the distal fragment about 2 cm from the fracture site. 1 mm stainless steel wire is passed through the transverse hole then crossed over the posterior surface of the olecranon in a figure of eight loop passing through the triceps aponeurosis adjacent to bone and around the kirschner wires.The free ends of the stainless steel wire are tightened together.The proximal ends of the kirschner wires are bent 180 degrees and buried beneath the triceps fibers. For hook plate provisional fixation by two K-wires, small splitting of triceps over the tip of olecranon to allow application of the hook of plate, then long small set partially serrated applied in first hole to be inter-fragmentally through the fracture then the remaining holes are filled for completing the fixation. After removal of the K-wires and checking the stability closure of layers was done.
The operated limb was immobilized in an above elbow back slab for 2 weeks to allow incision healing, then all patients start mobilization after these 2 weeks to allow gaining full range of motion and avoid stiffness.
Among this study there were twenty patients with mean age 33.900± 12.8 years with age range 20-74 years. Ten patients (50%) were left elbow affected and ten patients (50%) were right elbow affected, 4 patients (20%) presented with direct trauma while 9 patients (45%) had indirect trauma and 7 patients (35%) had combined mechanism of trauma. This study included 10 patients (50%) with non-comminuted stable fracture, 4 patients (20%) were stable comminuted fractures, 3 patients (15%) were unstable non-comminuted fractures and 3 patients were unstable comminuted fractures. The occupation of these patients were 9 (45%) light manual workers, 7 (35%) moderate workers, 4 (20%) heavy workers. The time lapsed before surgery was ranged from 2 days to 7 days. Postoperatively all patients were immobilized in above elbow back slab 16 patients (80%) kept in slab for 2 weeks, while 4 (20%) kept in slab 4 weeks.
At the end of follow up period which ranged from (6-12 months), with mean 9.4±1.2 months the results were assessed using a scoring system modified according to Murphy et al. which include assessment of pain, function, range of motion and radiological examination.
The final results at the end of the follow up period for tension band wiring patients was 10 patients (100%) ended with satisfactory results (score 17 -19 points), while for hook plate patients 9 (90%) ended with satisfactory results with (score 17-19 points) and one patient (10%) ended with unsatisfactory results (score 15 points).
There was no statistically significant difference between age and final score between the two groups. But there was a positive correlation between gender and final score at the two groups and that was statistically significant only in (TBW) group , side affection showed no statistical significance. There was appositive correlation between fracture classification and final score in the two groups but that was not statistically significant. And there were positive correlation between time lapsed before surgery and comminution in relation to final score, and that was only statistical significance with the time lapsed before surgery in hook plate group but no significance with comminution.