Innovating olecranon fracture fixation: the new eyelet pin system versus conventional techniques in mayo type 2A and 2B fractures

ABSTRACT Background: Olecranon fractures are common injuries of the elbow, accounting for approximately 10% of upper extremity fractures. Displaced olecranon fractures (Mayo type 2A/2B) typically require surgical fixation. Tension band wiring (TBW) is the standard for simple olecranon fractures, but it has a high rate of hardware complications. Locking plate fixation (PF) yields similar outcomes to TBW with fewer hardware issues but a higher risk of serious complications. The Eyelet Pin System (EPS) modifies TBW by using intramedullary pins with eyelets to secure the wire, to prevent K-wire back-out and reduce complications. This study compared EPS vs TBW and PF. Methods: A prospective cohort of 223 adults with displaced Mayo 2A/2B olecranon fractures underwent one of three fixation techniques: EPS (TBW with eyelet pins), standard TBW, or a locking plate (PF). Elbow range of motion (ROM) and functional outcomes (MEPS and DASH questionnaire) were evaluated at ~18 months post-surgery. Complications and reoperations were recorded. Results: 223 patients (EPS=78, TBW=69, PF=76) were included. EPS surgeries were shorter (55 vs 62 vs 70 min) and final ROM greater (flexion ~135° vs 125–128°, extension loss ~1° vs ~5°; p<0.05) than in TBW or PF groups. EPS had the highest mean MEPS (96.7 vs ~93–94 in TBW/PF, p<0.05), while DASH scores were similar. EPS also had the lowest complication rate (19% vs 36% TBW vs 25% PF) and far fewer reoperations (3.8% vs 24.6% vs 10.5%). No EPS patient experienced hardware migration or nerve injury, in contrast to TBW/PF. Conclusions: The Eyelet Pin System (EPS) showed superior clinical outcomes, with lower complication and reoperation rates compared to tension band wiring (TBW) and locking plate fixation. EPS provided the best elbow range of motion and functional scores, while virtually eliminating hardware migration. Although TBW and locking plates offered satisfactory healing, they required more secondary surgeries, mainly for hardware issues. The EPS technique retains the benefits of tension band fixation while addressing its main drawbacks. Keywords: Olecranon fracture; Tension band wiring; Eyelet pin; Olecranon plate fixation.