Biomechanical study on different internal fixation methods for treating Mayo type IIA olecranon fractures of the ulna

Biomechanical study on different internal fixation methods for treating Mayo type IIA olecranon fractures of the ulna | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Biomechanical study on different internal fixation methods for treating Mayo type IIA olecranon fractures of the ulna Jun Zhang, Yuqin Fang, Yunqiang Zhuang, Fude Jiao, Yang Gu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7153724/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract Background :The aim of this experiment is to compare the biomechanical strength of six distinct internal fixation techniques for Mayo type II olecranon fractures using biomechanical analysis. Methods : This study utilized tensile tests on artificial, shape-mimicking olecranon bones to assess their biomechanical properties. A tensile test was performed on the artificial, shape-mimicking olecranon bone at a 90° angle, with the tensile load applied at a rate of 2 mm/min until the test displacement reached 2 mm, at which point the test was halted. Throughout the test, the testing system was able to collect load and displacement data in real-time and simultaneously monitor the changes in the load-displacement relationship. Results : The maximum loads for groups A1-A6 were (75.34 ± 2.54), (85.53 ± 2.45), (106.57 ± 3.57), (115.21 ± 11.96), (92.76 ± 3.22), and (147.19 ± 4.29) N, respectively, and the stiffnesses were (33.46 ± 2.96), (39.29 ± 1.12), (51.07 ± 3.22), (53.76 ± 5.26), (40.99 ± 1.34), and (71.66 ± 1.77) N/mm, respectively. Conclusions : When the implantation depth of the Kirschner wires reached four times the standard deviation depth, its maximum load and stiffness performance were superior to those of the double cortical Kirschner wire tension band fixation. Health sciences/Anatomy Physical sciences/Engineering Health sciences/Health care Health sciences/Medical research biomechanics k-wire Intramedullary fixation，olecranon fractures tension band wiring Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Intruduction Olecranon fractures account for 8 to 10% of all elbow fractures, exhibiting a bimodal distribution. 1 . The Mayo classification is currently commonly used in clinical practice:Type I: Non-displaced fracture;Type II: Stable fracture, either non-comminuted or comminuted;Type III: Unstable fracture, either non-comminuted or comminuted. Involving the semilunar notch of the ulna, open reduction and internal fixation, including plate fixation and tension band wiring (TBW), is essential for achieving satisfactory results and has been utilized in clinical practice. 2 – 4 . Tension band wiring, regarded as the standard treatment, remains the most commonly used technique in the management of displaced and minimally comminuted olecranon fractures 5 , 6 . However, in recent studies 7 , we found that the failure rate of internal fixation using the standard Kirschner wire tension band technique was as high as (39.6%). When the Kirschner wire is implanted too deeply through the anterior cortex of the coronoid process, it can limit forearm rotation and increase the risk of heterotopic ossification and neurovascular injury.Therefore, In order to find the best fixed combination and structure of TBW, by analyzing the biomechanical stability of intramedullary Kirschner wire tension band fixation with four different Kirschner wire depths (2 times, 3 times, 4 times, and 5 times the standard deviation (the standard deviation being the vertical distance from the tip of the olecranon to the tip of the coronoid process of the ulna)) and comparing it with the biomechanical stability of bicortical Kirschner wire tension band and olecranon locking plate, we obtained the requirement for the shortest intramedullary Kirschner wire depth, providing a reference for clinical practice. Materials and Methods Specimen preparation and surgical procedures This study utilized artificial anatomical bones (3426 C01371) from Sawbones Company in the United States to investigate the biomechanical stability of intramedullary Kirschner wire tension band fixation with different Kirschner wire depths (2 times, 3 times, 4 times, and 5 times the standard deviation, with the standard deviation being the vertical distance from the tip of the olecranon to the tip of the coronoid process) and to compare it with the biomechanical stability of bicortical Kirschner wire tension band and olecranon locking plate.In this study, the Kirschner wires were implanted using the conventional resection method, that is, the olecranon of the ulna was cut open with a micro grinding saw. The artificial shaped bones were divided into 6 groups (3 pieces in each group, a total of 18 artificial shaped bones). In group A1, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 2 times the standard deviation (the standard deviation was the vertical distance from the tip of the olecranon to the tip of the coronoid process). In group A2, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 3 times the standard deviation. In group A3, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 4 times the standard deviation. In group A4, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 5 times the standard deviation. In group A5, the Kirschner wires passed through the cortical layer of the artificial shaped bone. In group A6, a locking plate was used to fix the shaped bone to create a proximal femoral fracture surgical model.(Fig. 1)The depth of needle placement was confirmed by measurement with a vernier caliper. After implantation, the structure of the bone implant was checked using an imaging device (high-frequency source mobile C-arm X-ray machine (BG9000-1 type)). (Fig. 1)The prepared models are shown in Figs. 1 to 6. After all samples were prepared, the prepared models were embedded and fixed in the pre-prepared bone cement for easy clamping. Biomechanical testing This study employed tensile tests on artificial anatomically-shaped olecranon bones to evaluate their biomechanical properties. Tensile tests applied in the 90° direction to the artificial anatomically-shaped olecranon bones can directly reflect the fixation performance of the implantation site on the artificial anatomically-shaped olecranon bones. The MTS Bionix858 hydraulic testing system was selected for the tests, which can perform tensile, compressive and torsional tests, with a static load range of 0 to 25 kN and a static torsion range of 0 to 250 N.m. Tensile test: The sample that has been embedded and fixed is locked onto the vertical fixture. A cylindrical fixture is used to hold the pulley groove position of the artificial bone model. After the fixation is completed, the artificial bone is kept horizontal (perpendicular to the direction of the load applied by the equipment). A cable is passed through the pre-drilled hole at the olecranon of the artificial bone model, and then the cable is fixed to the upper crossbeam of the testing equipment. The tensile test process adopts the displacement control mode, and the tensile load is stretched at a rate of 2mm/min until the test displacement reaches 2mm and the test is stopped. During the test, the testing system can collect load and displacement data in real time and monitor the load-displacement changes simultaneously.( The testing system is shown in Fig. 2.The experimental setup is shown in Fig. 3) Statistical analysis Analyses were performed using the SPSS software (SPSS Version 20; SPSS Inc., Chicago, IL, United States). Differences in stiffness and strength among the six fracture fixation groups were evaluated using Student's t - test, with significance set at P < 0.05. Results The maximum loads of groups A1-A6 were (75.34 ± 2.54), (85.53 ± 2.45), (106.57 ± 3.57), (115.21 ± 11.96), (92.76 ± 3.22), and (147.19 ± 4.29) N respectively, and the stiffnesses were (33.46 ± 2.96), (39.29 ± 1.12), (51.07 ± 3.22), (53.76 ± 5.26), (40.99 ± 1.34), and (71.66 ± 1.77) N/mm respectively. (Table 1 )The test results in Table 1 and Table 2 show that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. Next come the maximum load and stiffness of Groups A3 to A5, while the maximum load and stiffness of Groups A1 and A2 are the weakest. Based on the analysis of the results in Table 3 and Table 4 , there is no statistically significant difference in stiffness performance between Group A2 and Group A5 (P value > 0.05), indicating that the stiffness performance of the two groups is similar. However, there is a significant difference in maximum load performance between Group A2 and Group A5 (P value < 0.05), with the maximum load of Group A2 being approximately 7.8% lower than that of Group A5. Both the maximum load and stiffness performance of Group A3 and Group A5 show significant differences (P values < 0.05). The stiffness of Group A3 is approximately 15% higher than the maximum load of Group A5, and the stiffness of Group A3 is approximately 25% higher than that of Group A5. Both the maximum load and stiffness performance of Group A2 and Group A3 show significant differences (P values < 0.05). The stiffness of Group A2 is approximately 20% lower than the maximum load of Group A3, and the stiffness of Group A2 is approximately 23% lower than that of Group A3. Therefore, based on the test results in Table 3 and Table 4 , it can be concluded that among Group A2, Group A3, and Group A5, Group A3 has the best maximum load and stiffness performance. Next is Group A5, and Group A2 has the weakest maximum load and stiffness(Table 3 、4) Table 5 test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance.Table 5 test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance. Discussion 1. Advantages of ulnar tension band fixation The primary objective in the surgical treatment of olecranon fractures is to restore anatomical structure and ensure sufficient absolute stability. 8 The tension band wiring method is the gold standard for treating non-comminuted olecranon fractures. The traditional tension band technique involves the use of two intramedullary K-wires and wiring. 9 .TBW for Olecranon fracture of the ulna provide several advantages, including simplicity of the surgical technique, precise fixation and early mobilisation. The technical advantage of TBW is that the two K-wires or pins function as internal splints, distributing the forces applied to the fracture across the range of elbow joint motion.Moreover, the inclusion of the figure 8 configuration with K-wires offsets the tension applied to the elbow, Providing dynamic internal fixation and continuous pressure to promote fracture healing. 10 . The continuous improvements in the Total Body Water (TBW) technique have enhanced the fixation effect on olecranon fractures and reduced the risk of postoperative complications, including a significant decrease in the rate of fracture fixation failure. 11,12 .These modifications to the Tension Band Wiring (TBW) technique have reduced the volume of internal fixation and the risk of K-wire pull-out, while maintaining the TBW technique as the most cost-effective treatment option. 11,13 .The primary challenge of intramedullary K-wire placement is the instability of the construct. This instability may lead to complications, including proximal migration of the pins, displacement of the fracture line, and an unstable construct, potentially causing osteoarthritis in long-term follow-up.. 14 The test results of this study indicate that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. The maximum load and stiffness of Groups A3 to A5 rank just below that of Group A6. Conversely, Groups A1 and A2 exhibit the weakest maximum load and stiffness. This suggests that to achieve bicortical fixation, the intramedullary Kirschner wire tension band fixation must reach a depth of four times the standard deviation. 2. Biomechanical Analysis The experimental results indicate that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) significantly outperform those of the other groups. The maximum load and stiffness of Groups A1 (intramedullary Kirschner wire tension band fixation (at 2 times the standard deviation depth) to A4 (intramedullary Kirschner wire tension band fixation (at 5 times the standard deviation depth) improve with the increasing depth of Kirschner wire implantation into the bone marrow. Groups A3 (intramedullary Kirschner wire tension band fixation (at 4 times the standard deviation depth) and A4 exhibit higher maximum load and stiffness than Group A5 (bicondylar Kirschner wire tension band fixation), suggesting that when the Kirschner wire implantation depth reaches 4 times the standard deviation depth, its maximum load and stiffness surpass those of the bicondylar Kirschner wire tension band fixation. 3. Points to note for tension band fixation When employing the traditional Kirschner wire technique that passes through the double cortex, the tip of the Kirschner wire must not penetrate excessively into the anterior cortex of the ulna to prevent impairment of the patient's rotational function. Nevertheless, intramedullary fixation using Kirschner wires can effectively avert such complications. The steel wires on either side should be tightened concurrently to avoid any imbalance that could result from one side being overly taut. The tail of the Kirschner wire should be left with adequate length—approximately 5 to 10 mm—to allow for bending and embedding. Additionally, after bending the tail of the wire 180°, it should be driven into the bone to minimize skin irritation. 4. The shortcomings of this study This study has several limitations. Firstly, the small sample size of the fracture models and the single testing session may affect the findings. Secondly, the elbow is a complex joint, containing synovial fluid, multiple muscles, and ligaments. However, the biomechanical effects of soft tissues and other bony structures, such as the humerus and radius, were not included in our study. To study the biomechanics of elbow trauma, it is often challenging to establish a model that is both practically and ethically acceptable and also provides reliable results. Synbone models are frequently used in biomechanical experiments. Their advantages include uniform geometry and material properties, which eliminate sample variability due to factors such as age, sex, anatomy, demographics, and bone quality. Additionally, Synbone models are easier to obtain than cadaveric models. Conclusions Our biomechanical analyses indicate that the maximum load and stiffness of Group A3 (intramedullary Kirschner wire tension band fixation at 4 times the standard deviation depth) and Group A4 (intramedullary Kirschner wire tension band fixation at 5 times the standard deviation depth) surpass those of Group A5 (bicondylar Kirschner wire tension band fixation). This suggests that implanting the Kirschner wire at a depth of 4 times the standard deviation results in superior maximum load and stiffness performance compared to bicondylar Kirschner wire tension band fixation. Abbreviations K-wires Kirschner wires TBW Tension band wiring Declarations Funding Declaration This work was supported by the following funding sources: 1、Science and Technology Project of Yinzhou District (Project No: 2022AS062); 2、Medical and Health Science and Technology Project of Zhejiang Province (Project No: 2020KY892); 3、Ningbo Public Welfare Science and Technology Program Project (Project No: 2024S173); 4、Ningbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation (Project No:2024L004). The funders had no role in study design, data collection/analysis, decision to publish, or preparation of the manuscript. Data availability The datasets generated and analysed during the current study are not publicly available due to the research project is still being further developed and deepened but are available from the corresponding author on reasonable request. Author Contribution Jun Zhang and Yuqin Fang .wrote the main manuscript text and Fude Jiao.Yang Gu.prepared figures 1-5 and Yunqiang Zhuang .prepared tables 1-5. All authors reviewed the manuscript. References Cantore, M., Candela, V., Sessa, P., Giannicola, G. & Gumina, S. Epidemiology of isolated olecranon fractures: a detailed survey on a large sample of patients in a suburban area. JSES Int. 6 , 309–314. https://doi.org:10.1016/j.jseint.2021.11.015 (2022). Powell, A. J., Farhan-Alanie, O. M., Bryceland, J. K. & Nunn, T. The treatment of olecranon fractures in adults. Musculoskelet. Surg. 101 , 1–9. https://doi.org:10.1007/s12306-016-0449-5 (2017). Simpson, N. S., Goodman, L. A. & Jupiter, J. B. Contoured LCDC plating of the proximal ulna. Injury 27 , 411–417 (1996). Hume, M. C. & Wiss, D. A. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clinical Orthop. Relat. Research , 229–235 (1992). Den Hamer, A. et al. Current techniques for management of transverse displaced olecranon fractures. Muscles Ligaments Tendons J. 5 , 129–140 (2015). 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. 3 , 9. https://doi.org:10.1186/1749-799X-3-9 (2008). Powell, A. J., Farhan-Alanie, O. M. & McGraw, I. W. W. Tension band wiring versus locking plate fixation for simple, two-part Mayo 2A olecranon fractures: a comparison of post-operative outcomes, complications, reoperations and economics. Musculoskelet. Surg. 103 , 155–160. https://doi.org:10.1007/s12306-018-0556-6 (2019). Wilson, J., Bajwa, A., Kamath, V. & Rangan, A. Biomechanical comparison of interfragmentary compression in transverse fractures of the olecranon. J. Bone Joint Surg. Br. 93 , 245–250. https://doi.org:10.1302/0301-620X.93B2.24613 (2011). Di Francia, R. et al. Advantages of expulsion-proof pins in the treatment of olecranon fractures with tension band wiring: Comparison with a control group. Orthop. Traumatol. Surg. Res. 105 , 1593–1599. https://doi.org:10.1016/j.otsr.2019.08.020 (2019). Gierer, P., Wichelhaus, A. & Rotter, R. [Fractures of the olecranon]. Oper. Orthop. Traumatol. 29 , 107–114. https://doi.org:10.1007/s00064-017-0490-z (2017). Villanueva, P., Osorio, F., Commessatti, M. & Sanchez-Sotelo, J. Tension-band wiring for olecranon fractures: analysis of risk factors for failure. J. Shoulder Elb. Surg. 15 , 351–356. https://doi.org:10.1016/j.jse.2005.08.002 (2006). Chan, K. W. & Donnelly, K. J. Does K-wire position in tension band wiring of olecranon fractures affect its complications and removal of metal rate? J. Orthop. 12 , 111–117. https://doi.org:10.1016/j.jor.2014.04.018 (2015). DelSole, E. M., Pean, C. A., Tejwani, N. C. & Egol, K. A. Outcome after olecranon fracture repair: Does construct type matter? Eur. J. Orthop. Surg. Traumatol. 26 , 153–159. https://doi.org:10.1007/s00590-015-1724-0 (2016). 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 Elb. Surg. 21 , 405–411. https://doi.org:10.1016/j.jse.2011.07.022 (2012). Tables Table 1 Results of tensile tests on ulna fracture models Group Insertion method Maximum load（N） Stiffness （N/mm） A1 Intramedullary Kirschner wire tension band fixation (2 times the standard deviation depth) 75.34±2.54 33.46±2.96 A2 Intramedullary Kirschner wire tension band fixation (3 times the standard deviation depth) 85.53±2.45 39.29±1.12 A3 Intramedullary Kirschner wire tension band fixation (4 times the standard deviation depth) 106.57±3.57 51.07±3.22 A4 Intramedullary Kirschner wire tension band fixation (5 times the standard deviation depth) 115.21±11.96 53.76±5.26 A5 Double-cortex Kirschner wire tension band 92.76±3.22 40.99±1.34 A6 Ulnar olecranon locking plate 147.19±4.29 71.66±1.77 Test conclusion：Maximum load capacity：A6＞A4＞A3＞A5＞A2＞A1；Stiffness ：A6＞A4＞A3＞A5＞A2＞A1 Table 2 Statistical analysis results of the tensile test of the ulna fracture model Group Test items P value of difference analysis A5-A1 Maximum load （N） 0.002 Stiffness（N/mm） 0.016 A5-A2 Maximum load （N） 0.036 Stiffness（N/mm） 0.167 A5-A3 Maximum load （N） 0.008 Stiffness（N/mm） 0.007 A5-A4 Maximum load （N） 0.035 Stiffness（N/mm） 0.015 A5-A6 Maximum load （N） 0.00006 Stiffness（N/mm） 0.00002 The test results in Table 1 and Table 2 show that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. Next come the maximum load and stiffness of Groups A3 to A5, while the maximum load and stiffness of Groups A1 and A2 are the weakest. Table 3 Results and statistical analysis of maximum load tests for groups A2, A3, and A5 Test type Insertion method Maximum load capacity（N） P A2 A3 A5 Tensile test A2 85.53±2.45 P=0.001 A3 106.57±3.57 P=0.008 A5 92.76±3.22 P=0.036 Table 4 Stiffness test results and statistical analysis of groups A2, A3, and A5 Test type Insertion method Stiffness（N/mm） P A2 A3 A5 Tensile test A2 39.29±1.12 P=0.004 A3 51.07±3.22 P=0.007 A5 40.99±1.34 P=0.167 Based on the analysis of the results in Table 3 and Table 4, there is no statistically significant difference in stiffness performance between Group A2 and Group A5 (P value > 0.05), indicating that the stiffness performance of the two groups is similar. However, there is a significant difference in maximum load performance between Group A2 and Group A5 (P value < 0.05), with the maximum load of Group A2 being approximately 7.8% lower than that of Group A5. Both the maximum load and stiffness performance of Group A3 and Group A5 show significant differences (P values < 0.05). The stiffness of Group A3 is approximately 15% higher than the maximum load of Group A5, and the stiffness of Group A3 is approximately 25% higher than that of Group A5. There are also significant differences in both maximum load and stiffness performance between Group A2 and Group A3 (P values < 0.05). The stiffness of Group A2 is approximately 20% lower than the maximum load of Group A3, and the stiffness of Group A2 is approximately 23% lower than that of Group A3. Therefore, based on the test results in Table 3 and Table 4, it can be concluded that among Group A2, Group A3, and Group A5, Group A3 has the best maximum load and stiffness performance. Next is Group A5, and Group A2 has the weakest maximum load and stiffness performance. Table 5 Results of tensile tests on ulna fracture models in groups A1 to A4 Group Maximum load（N） Stiffness（N/mm） A1 75.34±2.54 33.46±2.96 A2 85.53±2.45 39.29±1.12 A3 106.57±3.57 51.07±3.22 A4 115.21±11.96 53.76±5.26 Table 5 test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 29 Oct, 2025 Reviews received at journal 29 Oct, 2025 Reviews received at journal 21 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers invited by journal 04 Aug, 2025 Editor assigned by journal 28 Jul, 2025 Editor invited by journal 28 Jul, 2025 Submission checks completed at journal 28 Jul, 2025 First submitted to journal 28 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7153724","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":495763007,"identity":"59923db5-61ab-4f2e-a66e-6cc298bd370c","order_by":0,"name":"Jun Zhang","email":"","orcid":"","institution":"Ningbo No.6 Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Zhang","suffix":""},{"id":495763008,"identity":"e6a07ba6-63ce-456b-b3e1-3e0d0f2761ce","order_by":1,"name":"Yuqin Fang","email":"","orcid":"","institution":"Ningbo No.6 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1","display":"","copyAsset":false,"role":"figure","size":120646,"visible":true,"origin":"","legend":"\u003cp\u003eDifferent internal fixation methods (A1-A6) for Mayo II fracture models and lateral views and X-ray of each group.A1.Intramedullary Kirschner wire tension band fixation (2 times the standard deviation depth).A2.Intramedullary Kirschner wire tension band fixation (3 times the standard deviation depth).A3.Intramedullary Kirschner wire tension band fixation (4 times the standard deviation depth).A4.Intramedullary Kirschner wire tension band fixation (5 times the standard deviation depth).A5.Double-cortical Kirschner wire tension bandA6.Ulnar olecranon locking plate.\u003cstrong\u003eStandard deviation depth:The standard deviation is the vertical distance from the tip of the olecranon to the tip of the coronoid process.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/f9abcf94c47d8d01f06e3b3c.png"},{"id":88458884,"identity":"089243ba-558f-437f-bd3f-81e67d58c887","added_by":"auto","created_at":"2025-08-06 15:59:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":188858,"visible":true,"origin":"","legend":"\u003cp\u003eMTS 858 BionixHydraulic testing system\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/afd6f8377fe5e45526ec742c.png"},{"id":88458887,"identity":"54f26770-1917-4a97-8393-f7c98398adb9","added_by":"auto","created_at":"2025-08-06 15:59:27","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":193843,"visible":true,"origin":"","legend":"\u003cp\u003eDiagram of tensile testing device\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/deee540c4873583cef6a0cbc.png"},{"id":88459236,"identity":"145100ef-ab08-4b8e-9f11-95f07743bdf6","added_by":"auto","created_at":"2025-08-06 16:07:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":37104,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart comparison of tensile tests on ulna fracture models\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/6e9ff5ae097c6b8d203598a0.png"},{"id":88459238,"identity":"8006414d-57a1-4faa-a6c9-f939a9b06b2c","added_by":"auto","created_at":"2025-08-06 16:07:27","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":62401,"visible":true,"origin":"","legend":"\u003cp\u003eTensile test curve diagram of ulna fracture model\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/f6e2df5ddd174fc0dca32e39.png"},{"id":100069041,"identity":"ab603663-ad0c-4b4d-ba4f-dea07c578b47","added_by":"auto","created_at":"2026-01-12 16:06:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1284518,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7153724/v1/c2397171-b5cc-406d-9477-2921f83fc751.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Biomechanical study on different internal fixation methods for treating Mayo type IIA olecranon fractures of the ulna","fulltext":[{"header":"Intruduction","content":"\u003cp\u003eOlecranon fractures account for 8 to 10% of all elbow fractures, exhibiting a bimodal distribution. \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The Mayo classification is currently commonly used in clinical practice:Type I: Non-displaced fracture;Type II: Stable fracture, either non-comminuted or comminuted;Type III: Unstable fracture, either non-comminuted or comminuted. Involving the semilunar notch of the ulna, open reduction and internal fixation, including plate fixation and tension band wiring (TBW), is essential for achieving satisfactory results and has been utilized in clinical practice.\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Tension band wiring, regarded as the standard treatment, remains the most commonly used technique in the management of displaced and minimally comminuted olecranon fractures\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. However, in recent studies\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, we found that the failure rate of internal fixation using the standard Kirschner wire tension band technique was as high as (39.6%). When the Kirschner wire is implanted too deeply through the anterior cortex of the coronoid process, it can limit forearm rotation and increase the risk of heterotopic ossification and neurovascular injury.Therefore, In order to find the best fixed combination and structure of TBW, by analyzing the biomechanical stability of intramedullary Kirschner wire tension band fixation with four different Kirschner wire depths (2 times, 3 times, 4 times, and 5 times the standard deviation (the standard deviation being the vertical distance from the tip of the olecranon to the tip of the coronoid process of the ulna)) and comparing it with the biomechanical stability of bicortical Kirschner wire tension band and olecranon locking plate, we obtained the requirement for the shortest intramedullary Kirschner wire depth, providing a reference for clinical practice.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eSpecimen preparation and surgical procedures\u003c/p\u003e\u003cp\u003eThis study utilized artificial anatomical bones (3426 C01371) from Sawbones Company in the United States to investigate the biomechanical stability of intramedullary Kirschner wire tension band fixation with different Kirschner wire depths (2 times, 3 times, 4 times, and 5 times the standard deviation, with the standard deviation being the vertical distance from the tip of the olecranon to the tip of the coronoid process) and to compare it with the biomechanical stability of bicortical Kirschner wire tension band and olecranon locking plate.In this study, the Kirschner wires were implanted using the conventional resection method, that is, the olecranon of the ulna was cut open with a micro grinding saw. The artificial shaped bones were divided into 6 groups (3 pieces in each group, a total of 18 artificial shaped bones). In group A1, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 2 times the standard deviation (the standard deviation was the vertical distance from the tip of the olecranon to the tip of the coronoid process). In group A2, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 3 times the standard deviation. In group A3, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 4 times the standard deviation. In group A4, the Kirschner wires were implanted into the medullary cavity of the shaped bone at 5 times the standard deviation. In group A5, the Kirschner wires passed through the cortical layer of the artificial shaped bone. In group A6, a locking plate was used to fix the shaped bone to create a proximal femoral fracture surgical model.(Fig.\u0026nbsp;1)The depth of needle placement was confirmed by measurement with a vernier caliper. After implantation, the structure of the bone implant was checked using an imaging device (high-frequency source mobile C-arm X-ray machine (BG9000-1 type)). (Fig.\u0026nbsp;1)The prepared models are shown in Figs.\u0026nbsp;1 to 6. After all samples were prepared, the prepared models were embedded and fixed in the pre-prepared bone cement for easy clamping.\u003c/p\u003e\u003cp\u003eBiomechanical testing\u003c/p\u003e\u003cp\u003eThis study employed tensile tests on artificial anatomically-shaped olecranon bones to evaluate their biomechanical properties. Tensile tests applied in the 90\u0026deg; direction to the artificial anatomically-shaped olecranon bones can directly reflect the fixation performance of the implantation site on the artificial anatomically-shaped olecranon bones. The MTS Bionix858 hydraulic testing system was selected for the tests, which can perform tensile, compressive and torsional tests, with a static load range of 0 to 25 kN and a static torsion range of 0 to 250 N.m.\u003c/p\u003e\u003cp\u003eTensile test: The sample that has been embedded and fixed is locked onto the vertical fixture. A cylindrical fixture is used to hold the pulley groove position of the artificial bone model. After the fixation is completed, the artificial bone is kept horizontal (perpendicular to the direction of the load applied by the equipment). A cable is passed through the pre-drilled hole at the olecranon of the artificial bone model, and then the cable is fixed to the upper crossbeam of the testing equipment. The tensile test process adopts the displacement control mode, and the tensile load is stretched at a rate of 2mm/min until the test displacement reaches 2mm and the test is stopped. During the test, the testing system can collect load and displacement data in real time and monitor the load-displacement changes simultaneously.( The testing system is shown in Fig.\u0026nbsp;2.The experimental setup is shown in Fig.\u0026nbsp;3)\u003c/p\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAnalyses were performed using the SPSS software (SPSS Version 20; SPSS Inc., Chicago, IL, United States). Differences in stiffness and strength among the six fracture fixation groups were evaluated using Student's t - test, with significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe maximum loads of groups A1-A6 were (75.34\u0026thinsp;\u0026plusmn;\u0026thinsp;2.54), (85.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45), (106.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.57), (115.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.96), (92.76\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22), and (147.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29) N respectively, and the stiffnesses were (33.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96), (39.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12), (51.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22), (53.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.26), (40.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34), and (71.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77) N/mm respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)The test results in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e show that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. Next come the maximum load and stiffness of Groups A3 to A5, while the maximum load and stiffness of Groups A1 and A2 are the weakest.\u003c/p\u003e\u003cp\u003eBased on the analysis of the results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there is no statistically significant difference in stiffness performance between Group A2 and Group A5 (P value\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that the stiffness performance of the two groups is similar. However, there is a significant difference in maximum load performance between Group A2 and Group A5 (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with the maximum load of Group A2 being approximately 7.8% lower than that of Group A5. Both the maximum load and stiffness performance of Group A3 and Group A5 show significant differences (P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The stiffness of Group A3 is approximately 15% higher than the maximum load of Group A5, and the stiffness of Group A3 is approximately 25% higher than that of Group A5. Both the maximum load and stiffness performance of Group A2 and Group A3 show significant differences (P values\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The stiffness of Group A2 is approximately 20% lower than the maximum load of Group A3, and the stiffness of Group A2 is approximately 23% lower than that of Group A3. Therefore, based on the test results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, it can be concluded that among Group A2, Group A3, and Group A5, Group A3 has the best maximum load and stiffness performance. Next is Group A5, and Group A2 has the weakest maximum load and stiffness(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e、4)\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance.Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e1. Advantages of ulnar tension band fixation\u003c/p\u003e\n\u003cp\u003eThe primary objective in the surgical treatment of olecranon fractures is to restore anatomical structure and ensure sufficient absolute stability.\u003csup\u003e8\u003c/sup\u003eThe tension band wiring method is the gold standard for treating non-comminuted olecranon fractures. The traditional tension band technique involves the use of two intramedullary K-wires and wiring.\u003csup\u003e9\u003c/sup\u003e.TBW for Olecranon fracture of the ulna provide several advantages, including simplicity of the surgical technique, precise fixation and early mobilisation. The technical advantage of TBW is that the two K-wires or pins function as internal splints, distributing the forces applied to the fracture across the range of elbow joint motion.Moreover, the inclusion of the figure 8 configuration with K-wires offsets the tension applied to the elbow, Providing dynamic internal fixation and continuous pressure to promote fracture healing.\u003csup\u003e10\u003c/sup\u003e .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe continuous improvements in the Total Body Water (TBW) technique have enhanced the fixation effect on olecranon fractures and reduced the risk of postoperative complications, including a significant decrease in the rate of fracture fixation failure. \u003csup\u003e11,12\u003c/sup\u003e.These modifications to the Tension Band Wiring (TBW) technique have reduced the volume of internal fixation and the risk of K-wire pull-out, while maintaining the TBW technique as the most cost-effective treatment option.\u003csup\u003e11,13\u003c/sup\u003e .The primary challenge of intramedullary K-wire placement is the instability of the construct. This instability may lead to complications, including proximal migration of the pins, displacement of the fracture line, and an unstable construct, potentially causing osteoarthritis in long-term follow-up..\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe test results of this study indicate that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. The maximum load and stiffness of Groups A3 to A5 rank just below that of Group A6. Conversely, Groups A1 and A2 exhibit the weakest maximum load and stiffness. This suggests that to achieve bicortical fixation, the intramedullary Kirschner wire tension band fixation must reach a depth of four times the standard deviation.\u003c/p\u003e\n\u003cp\u003e2. Biomechanical Analysis\u003c/p\u003e\n\u003cp\u003eThe experimental results indicate that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) significantly outperform those of the other groups. The maximum load and stiffness of Groups A1 (intramedullary Kirschner wire tension band fixation (at 2 times the standard deviation depth) to A4 (intramedullary Kirschner wire tension band fixation (at 5 times the standard deviation depth) improve with the increasing depth of Kirschner wire implantation into the bone marrow. Groups A3 (intramedullary Kirschner wire tension band fixation (at 4 times the standard deviation depth) and A4 exhibit higher maximum load and stiffness than Group A5 (bicondylar Kirschner wire tension band fixation), suggesting that when the Kirschner wire implantation depth reaches 4 times the standard deviation depth, its maximum load and stiffness surpass those of the bicondylar Kirschner wire tension band fixation.\u003c/p\u003e\n\u003cp\u003e3. Points to note for tension band fixation\u003c/p\u003e\n\u003cp\u003eWhen employing the traditional Kirschner wire technique that passes through the double cortex, the tip of the Kirschner wire must not penetrate excessively into the anterior cortex of the ulna to prevent impairment of the patient\u0026apos;s rotational function. Nevertheless, intramedullary fixation using Kirschner wires can effectively avert such complications. The steel wires on either side should be tightened concurrently to avoid any imbalance that could result from one side being overly taut. The tail of the Kirschner wire should be left with adequate length\u0026mdash;approximately 5 to 10 mm\u0026mdash;to allow for bending and embedding. Additionally, after bending the tail of the wire 180\u0026deg;, it should be driven into the bone to minimize skin irritation.\u003c/p\u003e\n\u003cp\u003e4. The shortcomings of this study\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. Firstly, the small sample size of the fracture models and the single testing session may affect the findings. Secondly, the elbow is a complex joint, containing synovial fluid, multiple muscles, and ligaments. However, the biomechanical effects of soft tissues and other bony structures, such as the humerus and radius, were not included in our study. To study the biomechanics of elbow trauma, it is often challenging to establish a model that is both practically and ethically acceptable and also provides reliable results. Synbone models are frequently used in biomechanical experiments. Their advantages include uniform geometry and material properties, which eliminate sample variability due to factors such as age, sex, anatomy, demographics, and bone quality. Additionally, Synbone models are easier to obtain than cadaveric models.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eOur biomechanical analyses indicate that the maximum load and stiffness of Group A3 (intramedullary Kirschner wire tension band fixation at 4 times the standard deviation depth) and Group A4 (intramedullary Kirschner wire tension band fixation at 5 times the standard deviation depth) surpass those of Group A5 (bicondylar Kirschner wire tension band fixation). This suggests that implanting the Kirschner wire at a depth of 4 times the standard deviation results in superior maximum load and stiffness performance compared to bicondylar Kirschner wire tension band fixation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eK-wires \u0026nbsp; Kirschner wires\u003c/p\u003e\n\u003cp\u003eTBW \u0026nbsp; \u0026nbsp; Tension band wiring\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the following funding sources:\u003c/p\u003e\n\u003cp\u003e1、Science and Technology Project of Yinzhou District (Project No: 2022AS062);\u003c/p\u003e\n\u003cp\u003e2、Medical and Health Science and Technology Project of Zhejiang Province (Project No: 2020KY892);\u003c/p\u003e\n\u003cp\u003e3、Ningbo Public Welfare Science and Technology Program Project (Project No: 2024S173);\u003c/p\u003e\n\u003cp\u003e4、Ningbo Clinical Research Center for Orthopedics, Sports Medicine \u0026amp; Rehabilitation (Project No:2024L004).\u003c/p\u003e\n\u003cp\u003eThe funders had no role in study design, data collection/analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due to the research project is still being further developed and deepened but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJun Zhang and Yuqin Fang .wrote the main manuscript text and Fude Jiao.Yang Gu.prepared figures 1-5 and Yunqiang Zhuang .prepared tables 1-5. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCantore, M., Candela, V., Sessa, P., Giannicola, G. \u0026amp; Gumina, S. Epidemiology of isolated olecranon fractures: a detailed survey on a large sample of patients in a suburban area. \u003cem\u003eJSES Int.\u003c/em\u003e \u003cb\u003e6\u003c/b\u003e, 309\u0026ndash;314. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.jseint.2021.11.015\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.jseint.2021.11.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePowell, A. J., Farhan-Alanie, O. M., Bryceland, J. K. \u0026amp; Nunn, T. The treatment of olecranon fractures in adults. \u003cem\u003eMusculoskelet. 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Res.\u003c/em\u003e \u003cb\u003e105\u003c/b\u003e, 1593\u0026ndash;1599. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.otsr.2019.08.020\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.otsr.2019.08.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGierer, P., Wichelhaus, A. \u0026amp; Rotter, R. [Fractures of the olecranon]. \u003cem\u003eOper. Orthop. Traumatol.\u003c/em\u003e \u003cb\u003e29\u003c/b\u003e, 107\u0026ndash;114. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s00064-017-0490-z\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s00064-017-0490-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVillanueva, P., Osorio, F., Commessatti, M. \u0026amp; Sanchez-Sotelo, J. Tension-band wiring for olecranon fractures: analysis of risk factors for failure. \u003cem\u003eJ. Shoulder Elb. Surg.\u003c/em\u003e \u003cb\u003e15\u003c/b\u003e, 351\u0026ndash;356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.jse.2005.08.002\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.jse.2005.08.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2006).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChan, K. W. \u0026amp; Donnelly, K. J. Does K-wire position in tension band wiring of olecranon fractures affect its complications and removal of metal rate? \u003cem\u003eJ. Orthop.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e, 111\u0026ndash;117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.jor.2014.04.018\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.jor.2014.04.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2015).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDelSole, E. M., Pean, C. A., Tejwani, N. C. \u0026amp; Egol, K. A. Outcome after olecranon fracture repair: Does construct type matter? \u003cem\u003eEur. J. Orthop. Surg. Traumatol.\u003c/em\u003e \u003cb\u003e26\u003c/b\u003e, 153\u0026ndash;159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1007/s00590-015-1724-0\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1007/s00590-015-1724-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan der Linden, S. C., van Kampen, A. \u0026amp; 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. \u003cem\u003eJ. Shoulder Elb. Surg.\u003c/em\u003e \u003cb\u003e21\u003c/b\u003e, 405\u0026ndash;411. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.jse.2011.07.022\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.jse.2011.07.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2012).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 Results of tensile tests on ulna fracture models\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eInsertion method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eMaximum load（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eStiffness （N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eIntramedullary Kirschner wire tension band fixation (2 times the standard deviation depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e75.34\u0026plusmn;2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e33.46\u0026plusmn;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eIntramedullary Kirschner wire tension band fixation (3 times the standard deviation depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e85.53\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e39.29\u0026plusmn;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eIntramedullary Kirschner wire tension band fixation (4 times the standard deviation depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e106.57\u0026plusmn;3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e51.07\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eIntramedullary Kirschner wire tension band fixation (5 times the standard deviation depth)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e115.21\u0026plusmn;11.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e53.76\u0026plusmn;5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eDouble-cortex Kirschner wire tension band\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e92.76\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e40.99\u0026plusmn;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 44px;\"\u003e\n \u003cp\u003eUlnar olecranon locking plate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e147.19\u0026plusmn;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e71.66\u0026plusmn;1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp\u003eTest conclusion：Maximum load capacity：A6＞A4＞A3＞A5＞A2＞A1；Stiffness ：A6＞A4＞A3＞A5＞A2＞A1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 Statistical analysis results of the tensile test of the ulna fracture model\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"77%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eTest items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eP value of difference analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eA5-A1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMaximum load （N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eA5-A2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMaximum load （N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eA5-A3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMaximum load （N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eA5-A4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMaximum load （N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 33px;\"\u003e\n \u003cp\u003eA5-A6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eMaximum load （N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.00006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e0.00002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe test results in Table 1 and Table 2 show that the maximum load and stiffness of Group A6 (ulnar olecranon locking plate) are significantly superior to those of the other test groups. Next come the maximum load and stiffness of Groups A3 to A5, while the maximum load and stiffness of Groups A1 and A2 are the weakest.\u003c/p\u003e\n\u003cp\u003eTable 3 Results and statistical analysis of maximum load tests for groups A2, A3, and A5\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTest type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 30px;\"\u003e\n \u003cp\u003eInsertion method\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMaximum load capacity（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 37px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTensile test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e85.53\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eP=0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e106.57\u0026plusmn;3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eP=0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e92.76\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eP=0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 Stiffness test results and statistical analysis of groups A2, A3, and A5\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTest type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eInsertion method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 24px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 38px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003eTensile test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e39.29\u0026plusmn;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eP=0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e51.07\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eP=0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003eA5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e40.99\u0026plusmn;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003eP=0.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBased on the analysis of the results in Table 3 and Table 4, there is no statistically significant difference in stiffness performance between Group A2 and Group A5 (P value \u0026gt; 0.05), indicating that the stiffness performance of the two groups is similar. However, there is a significant difference in maximum load performance between Group A2 and Group A5 (P value \u0026lt; 0.05), with the maximum load of Group A2 being approximately 7.8% lower than that of Group A5. Both the maximum load and stiffness performance of Group A3 and Group A5 show significant differences (P values \u0026lt; 0.05). The stiffness of Group A3 is approximately 15% higher than the maximum load of Group A5, and the stiffness of Group A3 is approximately 25% higher than that of Group A5. There are also significant differences in both maximum load and stiffness performance between Group A2 and Group A3 (P values \u0026lt; 0.05). The stiffness of Group A2 is approximately 20% lower than the maximum load of Group A3, and the stiffness of Group A2 is approximately 23% lower than that of Group A3. Therefore, based on the test results in Table 3 and Table 4, it can be concluded that among Group A2, Group A3, and Group A5, Group A3 has the best maximum load and stiffness performance. Next is Group A5, and Group A2 has the weakest maximum load and stiffness performance.\u003c/p\u003e\n\u003cp\u003eTable 5 Results of tensile tests on ulna fracture models in groups A1 to A4\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"55%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003eMaximum load（N）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eStiffness（N/mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e75.34\u0026plusmn;2.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e33.46\u0026plusmn;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e85.53\u0026plusmn;2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e39.29\u0026plusmn;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eA3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e106.57\u0026plusmn;3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e51.07\u0026plusmn;3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eA4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e115.21\u0026plusmn;11.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e53.76\u0026plusmn;5.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 5 test results show that the maximum load and stiffness performance of groups A1 to A4 increase successively, indicating that as the implantation depth of Kirschner wires increases, their maximum load and stiffness performance improve. That is, an increase in the implantation depth of Kirschner wires can effectively enhance the maximum load and stiffness performance.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"biomechanics, k-wire, Intramedullary fixation，olecranon fractures, tension band wiring","lastPublishedDoi":"10.21203/rs.3.rs-7153724/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7153724/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:The aim of this experiment is to compare the biomechanical strength of six distinct internal fixation techniques for Mayo type II olecranon fractures using biomechanical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This study utilized tensile tests on artificial, shape-mimicking olecranon bones to assess their biomechanical properties. A tensile test was performed on the artificial, shape-mimicking olecranon bone at a 90° angle, with the tensile load applied at a rate of 2 mm/min until the test displacement reached 2 mm, at which point the test was halted. Throughout the test, the testing system was able to collect load and displacement data in real-time and simultaneously monitor the changes in the load-displacement relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The maximum loads for groups A1-A6 were (75.34 ± 2.54), (85.53 ± 2.45), (106.57 ± 3.57), (115.21 ± 11.96), (92.76 ± 3.22), and (147.19 ± 4.29) N, respectively, and the stiffnesses were (33.46 ± 2.96), (39.29 ± 1.12), (51.07 ± 3.22), (53.76 ± 5.26), (40.99 ± 1.34), and (71.66 ± 1.77) N/mm, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: When the implantation depth of the Kirschner wires reached four times the standard deviation depth, its maximum load and stiffness performance were superior to those of the double cortical Kirschner wire tension band fixation.\u003c/p\u003e","manuscriptTitle":"Biomechanical study on different internal fixation methods for treating Mayo type IIA olecranon fractures of the ulna","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 15:59:22","doi":"10.21203/rs.3.rs-7153724/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-29T17:23:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T05:15:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-22T02:19:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"251011928903991159746253978154719100462","date":"2025-10-07T01:09:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214335750355121843244322020095739565088","date":"2025-10-06T23:20:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151692084176334402377446848174917547373","date":"2025-09-16T17:06:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T15:01:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T18:05:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-28T18:00:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-28T07:34:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-28T07:31:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1b381253-62ff-4c8e-a0e4-127efca3f65e","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":52651405,"name":"Health sciences/Anatomy"},{"id":52651406,"name":"Physical sciences/Engineering"},{"id":52651407,"name":"Health sciences/Health care"},{"id":52651408,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-01-12T16:00:02+00:00","versionOfRecord":{"articleIdentity":"rs-7153724","link":"https://doi.org/10.1038/s41598-026-35057-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-09 15:57:02","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-08-06 15:59:22","video":"","vorDoi":"10.1038/s41598-026-35057-9","vorDoiUrl":"https://doi.org/10.1038/s41598-026-35057-9","workflowStages":[]},"version":"v1","identity":"rs-7153724","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7153724","identity":"rs-7153724","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}