JSES - 2026-08-01 - Journal Article; Consensus Statement
Defining technical competence in olecranon fracture fixation: an international Delphi consensus on tension band wiring assessment.
Nordlund E, Wenger D, Jacobsen ME, Nayahangan LJ, Ghidinelli M, Subramaniam C, Hare KB, Konge L, Gustafsson A
Topics
Key Takeaway
An international Delphi consensus of 98 AO faculty identified 43 parameters for assessing tension band wiring competence, with 'anatomical fracture reduction' scoring highest at 9.7/10 and a near-perfect importance-to-score correlation (r=0.91).
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Summary
This study used a 4-round modified Delphi process with 98 AO faculty to establish consensus assessment parameters for tension band wiring (TBW) of simple transverse olecranon fractures. From an initial pool of 46 proposed parameters, 43 were retained across four domains: fracture reduction (8), K-wire placement (14), cerclage wire configuration (18), and end-of-procedure verification (3). Anatomical reduction scored highest (9.7/10), and the strong correlation between importance ratings and final scores (r=0.91, p<0.001) confirms internal consistency of the tool.
Key Limitation
Round 3 score-range data for specific bone and fracture models were collected but not reported, leaving the tool's calibration for simulation platforms and objective scoring thresholds undefined.
Original Abstract
BACKGROUND
Tension band wiring (TBW) is a widely used technique for displaced olecranon fractures but carries a substantial risk of complications, often due to technical errors. Despite being a designated core competency in orthopedic curricula, no standardized, procedure-specific tool exists to assess technical performance in TBW. This study aimed to establish international expert consensus on assessment parameters for evaluating surgical competence in TBW of simple transverse olecranon fractures.
METHODS
A modified 4-round Delphi process was conducted with 98 orthopedic trauma surgeons, primarily Arbeitsgemeinschaft für Osteosynthesefragen faculty. In Round 1, panelists proposed key performance parameters and typical errors. Responses were analyzed and processed by a steering committee. In Round 2, 46 parameters were rated for importance using a 5-point Likert-like scale; parameters with mean scores ≥ 3.0 were retained. In Round 3, specific score ranges were determined for each bone and fracture model; these results are not presented in this study. In the final round, experts assigned scores (1-10) to each retained parameter to reflect its impact on procedural quality. Descriptive statistics were used, and Pearson's correlation coefficient assessed the relationship between importance ratings and scores.
RESULTS
A total of 43 parameters were retained, covering fracture reduction (8 items), K-wire placement (14), cerclage wire configuration (18), and end-of-procedure verification (3). The highest scoring parameter was "achieving anatomical fracture reduction" (mean score: 9.7), followed by "placement of the cerclage wire in a figure-of-8 configuration" (9.4). A very strong correlation was observed between importance and final scores (r = 0.91, P < .001), indicating internal consistency.
CONCLUSIONS
This international consensus study defines a comprehensive set of assessment parameters for TBW of olecranon fractures. The tool supports both structured evaluation and high-specificity feedback-key drivers of skill acquisition in competency-based surgical training. It may be used directly in feedback settings or adapted for simulation platforms and structured curricula.