Tension-band high-strength suture combined with absorbable screws with cortical penetration for treating Mayo type IIA olecranon fractures: finite element analysis, biomechanical testing, and clinical study

Objective Tension-band wiring with Kirschner wires (TBW) is a common surgical technique for olecranon fractures (OFs), but has limitations like implant removal and soft tissue irritation. Tension-band high-strength suture with absorbable screw (TBSAS) technique can effectively solve these issues. This study aims to demonstrate the biomechanical stability and clinical efficacy of the TBSASC technique for treating OFs (Mayo IIA) (AO 21-B1.1). Methods Four finite element models for OFs (Mayo IIA) compared fixation constructs: TBW with cortical penetration (TBWC), TBW with intramedullary fixation (TBWM), TBSAS with cortical penetration (TBSASC), and TBSAS with intramedullary fixation (TBSASM). Displacement and stress distributions were analyzed under various loading conditions. Corresponding 3D-printed physical models tested static tensile strength, fatigue resistance, and torsional stability. Clinically, 13 patients with OFs (Mayo IIA) treated with TBSASC between April 2023 and April 2025 were prospectively followed. Operative data, complications, fracture healing, range of motion, VAS pain score, and MEPS were recorded to assess safety and efficacy. Results Finite element analysis (FEA) showed the TBSASC group achieved mean fracture displacements slightly inferior but without statistical significance to the gold-standard TBWC group (max 0.192 mm vs. 0.178 mm, p > 0.05). TBSASC significantly reduced stress on both implants (max 79.99 MPa) and bone (85.80 MPa) compared to TBWC (464.82 MPa and 137.54 MPa, respectively). Biomechanically, TBSASC withstood physiological loads without failure, with its ultimate load, fatigue, and torsional resistance slightly inferior but without statistical significance to TBWC (p > 0.05). Clinically, 13 patients treated with TBSASC were followed for a mean of 14.7 months. Mean operative time was 66.1 min. Fractures healed by 7.1 weeks. Pain (VAS) decreased from 6.0 at 1 month to 0.15 at 6 months, and elbow function (MEPS) improved from 79.2 to 95.8 over 12 months, with 76.9% of patients very satisfied. No complications occurred. Conclusion The TBSASC technique demonstrates acceptable preliminary safety and feasibility for OFs (Mayo IIA), providing sufficient stability for fracture fixation and early functional exercise, effectively reducing complications associated with metal implants and trauma from secondary removal surgery, suggesting its potential as a promising alternative that warrants further investigation in larger, prospective comparative studies.