Background This study evaluates the efficacy of suture fixation for treating simple olecranon fractures, hypothesizing that it provides a low complication rate, low reoperation rate, and favorable functional outcomes compared to tension band wiring fixation. Methods Between 2017 and 2024, 34 patients with olecranon fractures were treated using tension suture fixation. There were 8 Mayo IA, 23 IIA, 1 IB and 2 IIB. Mean follow-up period was 31.4 months. Primary outcomes included complication and reoperation rates, radiographic healing time, while secondary outcomes included functional scores and range of motion. Results Only one patient required revision for failure of the tension suture fixation. One patient had a refracture revised with plate fixation. There were two superficial infections treated with oral antibiotics. Mean radiographic healing time was 1.48 ± 0.5 months. Mean extension 6.76° ± 10.14°, flexion 139.11° ± 5.83°, pronation 89.55° ± 1.43°, supination 89.70° ± 1.19°. Mean quick Disabilities of the Arm, Shoulder and Hand was 3.15 ± 5.28, Mayo Elbow Performance Score 95.3 ± 9.82, and numeric pain rating scale 1.2 ± 1.93. Conclusions Suture fixation is a reliable technique for simple olecranon fractures with low complication and reoperation rates compared to tension band wiring as reported in the literature. This technique is a viable alternative for treating these injuries. Level of evidence Level IV, Case Series, Prognostic study.
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