Scientific Article| Volume 47, ISSUE 8, P796.e1-796.e6, August 2022

Biomechanical Comparison of Dual and Posterior Locking Plates in an Ex Vivo Comminuted Olecranon Fracture Model

Published:January 12, 2022DOI:


      Comminuted olecranon fractures are commonly fixed with posterior locking plates (PLPs). Though biomechanically validated, this method comes with risks of symptomatic implant prominence and wound breakdown. Dual locking plates (DLPs) placed on the medial and lateral surfaces of the olecranon theoretically avoid these risks and allow for fixation of proximal fracture fragments in multiple planes. A biomechanical comparison of DLP and PLP fixation would help to validate the use of DLPs in comminuted olecranon fractures.


      Seven matched pairs of cadaveric upper extremities were evaluated with quantitative computed tomography scans to evaluate bone mineral density (BMD). Osteotomies simulating comminuted olecranon fractures (Mayo Type IIB) were created and the specimens were fixed either with variable angle PLPs or variable angle DLPs. The specimens were then cyclically loaded and loaded to failure. The ultimate strength, fracture displacement, and mechanism of failure were recorded and compared across groups. The correlation between BMD and ultimate strength was analyzed.


      The mean total BMD was 0.79 g/cm2 (SD, 0.14 g/cm2). No specimen failed during cyclic testing. Five of 7 PLP specimens and 5 of 7 DLP specimens failed by fracture through the proximal screws though in different planes (sagittal vs axial splits, respectively). The mean ultimate strengths of the PLP (1077 N [SD, 462 N]) and DLP (1241 N [SD, 506 N]) groups were similar. There was a linear relationship between ultimate strength and BMD (R2 = 0.33).


      Dual locking plates display biomechanical properties that suggest that they can be used in the fixation of comminuted olecranon fractures. Catastrophic failure of the fixation constructs occurs around stress risers at the proximal screws rather than due to displacement at the fracture itself.

      Clinical relevance

      Dual locking plate constructs can be considered for use in the fixation of comminuted olecranon fractures.

      Key words

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        • Wild J.R.
        • Askam B.M.
        • Margolis D.S.
        • Geffre C.P.
        • Krupinski E.A.
        • Truchan L.M.
        Biomechanical evaluation of suture-augmented locking plate fixation for proximal third fractures of the olecranon.
        J Orthop Trauma. 2012; 26: 533-538
        • Duckworth A.D.
        • Clement N.D.
        • Aitken S.A.
        • Court-Brown C.M.
        • McQueen M.M.
        The epidemiology of fractures of the proximal ulna.
        Injury. 2012; 43: 343-346
        • Duckworth A.D.
        • Bugler K.E.
        • Clement N.D.
        • Court-Brown C.M.
        • McQueen M.M.
        Nonoperative management of displaced olecranon fractures in low-demand elderly patients.
        J Bone Joint Surg Am. 2014; 96: 67-72
        • Veillette C.J.H.
        • Steinmann S.P.
        Olecranon fractures.
        Orthop Clin North Am. 2008; 39 (vii): 229-236
        • Hackl M.
        • Mayer K.
        • Weber M.
        • et al.
        Plate osteosynthesis of proximal ulna fractures-a biomechanical micromotion analysis.
        J Hand Surg Am. 2017; 42: 834.e1-834.e7
        • Hume M.C.
        • Wiss D.A.
        Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation.
        Clin Orthop Relat Res. 1992; 285: 229-235
        • Izzi J.
        • Athwal G.S.
        An off-loading triceps suture for augmentation of plate fixation in comminuted osteoporotic fractures of the olecranon.
        J Orthop Trauma. 2012; 26: 59-61
        • Morwood M.P.
        • Ruch D.S.
        • Leversedge F.J.
        • Mithani S.K.
        • Kamal R.N.
        • Richard M.J.
        Olecranon fractures with sagittal splits treated with dual fixation.
        J Hand Surg Am. 2015; 40: 711-715
        • Gordon M.J.
        • Budoff J.E.
        • Yeh M.L.
        • Luo Z.P.
        • Noble P.C.
        Comminuted olecranon fractures: a comparison of plating methods.
        J Shoulder Elbow Surg. 2006; 15: 94-99
        • Shin H.D.
        • Yang J.H.
        • Kim P.S.
        Internal fixation using double plates for comminuted olecranon fractures in adults.
        J Korean Fract Soc. 2009; 22: 166
        • Ring D.
        • Tavakolian J.
        • Kloen P.
        • Helfet D.
        • Jupiter J.B.
        Loss of alignment after surgical treatment of posterior monteggia fractures: salvage with dorsal contoured plating.
        J Hand Surg Am. 2004; 29: 694-702
        • Rochet S.
        • Obert L.
        • Lepage D.
        • Lemaire B.
        • Leclerc G.
        • Garbuio P.
        Proximal ulna comminuted fractures: fixation using a double-plating technique.
        Orthop Traumatol Surg Res. 2010; 96: 734-740
        • Fantry A.J.
        • Sobel A.D.
        • Capito N.
        • et al.
        Biomechanical assessment of locking plate fixation of comminuted proximal olecranon fractures.
        J Orthop Trauma. 2018; 32: e445-e450
        • Argintar E.
        • Martin B.D.
        • Singer A.
        • Hsieh A.H.
        • Edwards S.
        A biomechanical comparison of multidirectional nail and locking plate fixation in unstable olecranon fractures.
        J Shoulder Elbow Surg. 2012; 21: 1398-1405
        • Claessen F.M.A.P.
        • Braun Y.
        • Peters R.M.
        • Dyer G.
        • Doornberg J.N.
        • Ring D.
        Factors associated with reoperation after fixation of displaced olecranon fractures.
        Clin Orthop Relat Res. 2016; 474: 193-200
        • Siebenlist S.
        • Torsiglieri T.
        • Kraus T.
        • Burghardt R.D.
        • Stöckle U.
        • Lucke M.
        Comminuted fractures of the proximal ulna - preliminary results with an anatomically preshaped locking compression plate (LCP) system.
        Injury. 2010; 41: 1306-1311
        • Snoddy M.C.
        • Lang M.F.
        • An T.J.
        • et al.
        Olecranon fractures: factors influencing re-operation.
        Int Orthop. 2014; 38: 1711-1716
        • Bailey C.S.
        • MacDermid J.
        • Patterson S.D.
        • King G.J.
        Outcome of plate fixation of olecranon fractures.
        J Orthop Trauma. 2001; 15: 542-548
        • Niglis L.
        • Bonnomet F.
        • Schenck B.
        • et al.
        Critical analysis of olecranon fracture management by pre-contoured locking plates.
        Orthop Traumatol Surg Res. 2015; 101: 201-207
        • Buijze G.
        • Kloen P.
        Clinical evaluation of locking compression plate fixation for comminuted olecranon fractures.
        J Bone Joint Surg Am. 2009; 91: 2416-2420
        • Hutchinson D.T.
        • Horwitz D.S.
        • Ha G.
        • Thomas C.W.
        • Bachus K.N.
        Cyclic loading of olecranon fracture fixation constructs.
        J Bone Joint Surg Am. 2003; 85: 831-837
        • Edwards S.G.
        • Martin B.D.
        • Fu R.H.
        • et al.
        Comparison of olecranon plate fixation in osteoporotic bone: do current technologies and designs make a difference?.
        J Orthop Trauma. 2011; 25: 306-311
        • van der Linden S.C.
        • van Kampen A.
        • Jaarsma R.L.
        K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures.
        J Shoulder Elbow Surg. 2012; 21: 405-411
        • Chalidis B.E.
        • Sachinis N.C.
        • Samoladas E.P.
        • Dimitriou C.G.
        • Pournaras J.D.
        Is tension band wiring technique the “gold standard” for the treatment of olecranon fractures? A long term functional outcome study.
        J Orthop Surg Res. 2008; 3: 9