Tension Band Construct Research Articles

Removal of the Metaphyseal Screw From Tension Band Constructs After Hemiepiphysiodesis: High Rates of Physeal Tethering and Subsequent Implant Removal.

Removal of the metaphyseal screw from tension band plate constructs after correction of angular deformity in patients treated with hemiepiphysiodesis has been suggested as an alternative to removing the plate and both screws. While this has the potential benefit of easier implant removal and reinsertion in the event of rebound, there is debate in the literature regarding the benefits and risks of leaving the epiphyseal screw and plate in place. Patients treated with hemiepiphysiodesis at the distal femur and/or proximal tibia with tension band plates and screws who underwent subsequent removal of the metaphyseal screw after correction were included. Charts and radiographs were reviewed for the need for metaphyseal screw reinsertion, subsequent removal of deep implants, and evidence of physeal tethering. Tethering was defined as progressive overcorrection in the treated bone segment after removal of the metaphyseal screw with the mechanical axis moving one full mechanical axis zone or more. Patients with tethering were compared with those without. A total of 215 patients with 387 limbs treated met inclusion criteria. Of those, 175 patients were treated for idiopathic genu valgum, while 40 were treated for other conditions. Fifty-nine individuals (27%) underwent replacement of the metaphyseal screw for repeat angular correction. Fifty-one percent of patients underwent secondary procedures for reasons other than metaphyseal screw reinsertion (74 symptomatic implant removal, 7 elective implant removal, 29 due to tethering). There were 44 cases of tethering in 36 patients (17%). In cases of tethering, 7 patients were treated with observation, 11 with implant removal only, 16 with hemiepiphysiodesis on the opposite side, and 2 with osteotomy. Patients with tethering were significantly younger, more likely to be male, and more likely to have had the metaphyseal screw removed more than once (P < 0.05). Removal of only the metaphyseal screw after hemiepiphysiodesis has high rates of tethering and further surgery for iatrogenic deformity correction and implant removal. This technique is not recommended. Therapeutic Level III, case-control study.

Radiographic and Functional Outcomes Following Resorbable Screw-Augmented Suture Fixation vs. All-Suture Fixation of Mid-pole Patellar Fractures: A Comparative Case Series.

Purpose Midpole patellar fractures are traditionally fixed with an "11-8" metal tension band construct. However, this technique is rife with implant-related complications. This study aims to evaluate the radiographic and functional outcomes following "all-suture" fixation of mid-pole patellar fractures as compared to resorbable screw-augmented suture fixation. Methods We retrospectively studied a consecutive series of 18 patients, 9 each with mid-pole patellar fractures treated with all-suture fixation or suture fixation augmented with bioabsorbable cancellous screws in our institution. The hybrid fixation cohort was significantly older (p<0.01). Radiographic and functional outcomes, such as time to union, postoperative range of motion (ROM), and the presence of complications such as fracture displacement were recorded and evaluated. The minimum follow-up was one year. Results All cases achieved radiographic union by 15 weeks postoperatively except one from the hybrid fixation cohort. The average time to radiographic union was comparable (p=0.30). Twenty-two point two percent (22.2%; 2 out of 9) of the cases from each cohort had an increase in the fracture gap (>2 mm) at around four to six weeks postoperatively, for which all except one case from the hybrid fixation cohort achieved union thereafter. One patient from the hybrid fixation cohort had fibrous non-union and further fracture displacement. There was another case of mild fracture gapping and screw breakage on review of postoperative radiographs at three months from the hybrid fixation cohort. These patients recovered without surgical revision or implant removal. Conclusions Both non-metal fixation methods for mid-pole transverse patellar fractures proved to be radiographically and functionally comparable.

Olecranon Osteotomy Exposure for Distal Humeral Fracture Treatment.

Olecranon osteotomy (OO) is commonly utilized to improve exposure when treating intra-articular distal humeral fractures. A chevron-shaped osteotomy facilitates reduction and increases surface area for healing1. Following distal humeral fracture reduction and fixation, the OO fragment is fixed with a precontoured plate. The OO technique yields comparable outcomes to alternative techniques1,2. The technique is performed as follows. (1) Imaging is reviewed and preoperative planning is performed. (2) The patient is positioned in the lateral decubitus position with the operative extremity placed over a bolster. (3) A longitudinal posterior skin incision is centered just medial or lateral to the tip of the olecranon. Full-thickness skin flaps are raised medially and laterally. (4) The ulnar nerve is identified and mobilized for later anterior subcutaneous transposition. (5) An OO is performed at the non-articular "bare area" of the trochlear notch with an oscillating saw and completed with an osteotome. (6) Open reduction and internal fixation of the distal humerus is performed. (7) The osteotomy fragment is reduced, and a precontoured plate is applied. (8) A small longitudinal slit in the distal triceps over the proximal edge of the plate decreases plate prominence and is repaired with suture. (9) The subcutaneous tissues and skin are closed in the usual manner. Alterative techniques include extra-articular OO, triceps splitting, triceps reflecting, and lateral para-olecranon combined with a medial approach. Multiple drill holes and a thin osteotome can help mitigate the kerf created by the oscillating saw. Alternative fixation methods include a predrilled 6.5-mm intramedullary screw, a tension band construct, suture fixation, or a one-third tubular plate. The OO technique provides improved exposure when compared with alternative techniques, enabling accurate reduction and fixation of distal humeral fractures1-3. Wilkinson and Stanley found that OO exposed the distal humeral articular surface to a greater degree than the triceps-splitting and triceps-reflecting approaches3. OO has not been associated with triceps weakness, unlike some of the alternative techniques2. The incidence of good-to-excellent outcomes is similar when comparing the techniques for exposure of intra-articular distal humeral fractures4. Osteotomies united in all patients in 2 reported series, totaling 84 cases1,2. Removal of symptomatic hardware used in OO fragment fixation can occur in a small subset of patients1,2. Provisionally size a precontoured plate and fix it on the olecranon to aid in later reduction and fracture fixation.The bare area is the desired position for the OO because of its natural lack of cartilage5,6. This non-articular bare area is located just distal to the deepest portion of the trochlear notch, approximately 2 to 2.5 cm distal to the olecranon tip5,6.An (apex-distal) chevron osteotomy angle of ∼130° will help to keep the osteotomy within the non-articular bare area6.Beginning on the dorsal surface of the ulna, directly posterior to the bare area, an oscillating saw is utilized to create a chevron osteotomy to subchondral bone, perpendicular to the long axis of the ulna5,6.The OO is completed by fracturing through the osteochondral surface, which leaves an irregular chondral cancellous surface that can accurately interdigitate. This facilitates later reduction and stability of the osteotomy.Anatomic articular reduction of the OO is not solely judged on the dorsal cortical bone because of the kerf removed by the saw blade. Instead, examination of the articular surface of the trochlear notch is the primary assessment of reduction.Placement of suture through the proximal portion of the plate aids in the repair of the longitudinal split of the distal triceps.Successful treatment of distal humeral fractures requires accurate reduction and rigid fixation aided by adequate exposure achieved through OO. ORIF = open reduction and internal fixationOT = occupational therapyHWR = hardware removalK-wire = Kirschner wireROM = range of motion.

Arthroscopically Assisted, Minimally Invasive Percutaneous Fixation of a Patellar Fracture

Operative fixation of a patellar fracture can be accomplished through a variety of techniques. However, drawbacks have been associated with many of these techniques, including painful hardware, poor skin healing due to bruising and swelling, inadequate cartilage reduction, and eventual post-traumatic osteoarthritis. Throughout the orthopaedic field, minimally invasive approaches have become popular. We describe an arthroscopically assisted method for ensuring fracture reduction intraoperatively and addressing associated defects while the patella is stabilized using a minimally invasive percutaneous fixation technique with screws and a tension band construct.

Olecranon fracture fixation with tension band construct after total elbow arthroplasty

PurposeOlecranon fractures are a known and potentially devastating complication of total elbow arthroplasty (TEA), especially if displaced with an incompetent extensor mechanism. The purpose of this study is to present a case series of olecranon fractures after TEA treated with a tension band construct and compare functional results to uncomplicated TEA patients. MethodsSix patients with displaced olecranon fractures in the setting of a prior TEA were identified and included in this retrospective case series. All patients were treated with a tension band construct. Functional scores were collected at a minimum of 1 year postoperatively, including the Mayo Elbow Performance Score (MEPS) and Single Assessment Numeric Evaluation (SANE) elbow score. Radiographs were reviewed at the time of injury and at the latest follow-up for fracture displacement, implant loosening or failure, and osseous union. A matched control group of 10 TEAs without complication was identified for comparison of functional scores. ResultsOne patient was deceased prior to the final follow-up and was not included in the functional score analysis. The average postoperative MEPS was 74 ± 18.5 and the average postoperative SANE score was 69.4 ± 13.7. Average final range of motion was 134 degrees flexion and 18 degrees extension. Three (50%) patients had radiographic signs of osseous union at an average of 3.4 months. One patient had fixation failure and subsequent triceps insufficiency and required multiple reoperations with poor functional scores at the final follow-up. No significant difference was noted in both postoperative MEPS (P = .503) and SANE (P = .142) when comparing patients with olecranon fracture to matched uncomplicated TEA patients. ConclusionTension band fixation of olecranon fractures after prior TEA is able to restore function for a difficult problem despite a 50% radiographic union rate. Patients with this complication can expect similar functional results to uncomplicated TEA patients with proper fixation.

Loop Anchor Tension Band Fixation for Olecranon Fractures and Chevron Olecranon Osteotomy.

Although tension band wiring is effective for treating olecranon fractures, it is associated with a high reoperation rate because of hardware-related problems. The loop anchor tension band technique is a novel modification of the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-modified tension band wiring technique. This technique is suitable for treating olecranon fractures without severe comminution and olecranon osteotomy. In the current case series, 2 intramedullary 1.25-mm Kirschner wires (K wires) were inserted as temporary fixation into the ulnar shaft from the olecranon after anatomical reduction. The proximal end of each K-wire was bent into a loop shape and advanced deep into the triceps tendon. A transverse hole was drilled distal to the fracture site, and a 1.0-mm metal wire was passed through the bone tunnel and the loops. The wire was tightened to form a figure-of-eight tension band construct. In total, 10 patients with a mean age of 49 (range: 19 to 85) years were included in this pilot series. The mean and minimum follow-up periods were 13.9 and 12 months, respectively. All fractures achieved favorable union, both radiographically and clinically. The mean QuickDASH score was 15.4 (range: 13.6 to 18.2) and the mean Mayo elbow performance score was 94 (range: 85 to 100). None of the patients experienced K-wire migration. The loop anchor tension band technique is a simple, cost effective modification of conventional tension band wiring and exhibited no implant migration in a pilot series.

Radiographic Evaluation of Isolated Continuous Compression Staples for Akin Osteotomy Fixation

Continuous compression implants (nitinol staples) are gaining popularity secondary to their lower profile, less demanding technique, and less surgical dissection. Biomechanical support exists; however, clinical data is limited in the foot/ankle. This study's purpose is to determine the efficacy of nitinol staples to achieve stable, bony healing in Akin osteotomies and examine their clinical outcomes, complications, re-operations, and pain scores. We performed a retrospective chart review on 90 patients (93 osteotomies) who underwent an Akin osteotomy using a nitinol staple over a 2-year period. Radiographs were randomized and independently reviewed by 3 blinded foot and ankle surgeons. Osteotomies were deemed healed if greater than 50% of the osteotomy contained bridging bone, partially healed as less than 50% bridging bone, and nonunion as no healing, broken hardware, or loss of reduction. Visual analog scale pain scores were analyzed. Radiographic union was seen in 98.9% of Akin osteotomies (92/93), with no loss of reduction or broken staples (0/95). Only 3.2% (3/93) of patients returned to the operating room unplanned: 1 infection (1.1%), 1 symptomatic hardware removal (1.1%), and 1 traumatic disruption of fixation (1.1%). Postoperative pain scores were significantly lower than preoperative. Staples are lower profile and technically less demanding compared to headed screws, plates, and tension band constructs. They offer continuous compression of the osteotomy and are rigid enough to maintain reduction. Based on the findings of this paper, the use of staples provides robust and stable fixation for Akin osteotomies and has low complication and high healing rates.

A new all-suture tension band tape fixation technique for simple olecranon fractures versus conventional tension band wire fixation: a comparative biomechanics study.

Simple transverse or short oblique olecranon fractures without articular comminution are classified as Mayo type IIA fractures and are typically treated with a tension band wire construct. Because of the high reoperation rates, frequently because of prominent hardware, all-suture tension band constructs have been introduced. It was the purpose to compare the biomechanical performance of conventional tension band wire fixation with a new all-suture tension band tape fixation for simple olecranon fractures. Mayo type IIA olecranon fractures were created in 20 cadaveric elbows from 10 donors. One elbow of each donor was randomly assigned to the tension band wire technique (group TBW) or tension band tape (Arthrex, 1.3-mm SutureTape) technique (group TBT). Both groups were cyclically loaded with 500 N over 500 cycles, after which a uniaxial displacement was performed to evaluate load to failure. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, where failure was defined as fracture gap formation greater than 4.0 mm. There was no significant difference in gap formation after 500 cycles between the TBW (1.8 mm±1.3 mm) and the TBT (1.9 mm±1.1 mm) groups (P=.854). The TBT showed a tendency toward greater construct stiffness compared with the TBW construct (mean difference: 142 N/mm; P=.053). Ultimate load to failure was not significantly different comparing both groups (TBW: 1138 N±286 N vs. TBT: 1126 N±272 N; P=.928). In both groups, all repairs failed because of >4.0-mm gap formation at the fracture site and none because of tension band construct breakage. Our study shows that the TBT technique produces equivalent or superior biomechanical performance to the TBW for simple olecranon fractures. The TBT approach reduces the risk of hardware prominence and as a result mitigates against the need for hardware removal. The TBT technique offers a clinically viable alternative to TBW.

A cortical screw based tension band construct for transverse patella fractures: An evolving strategy for addressing common modes of failure

IntroductionDisplaced patella fractures represent a clinical challenge. We evaluate the effectiveness of an alternative fixation construct to address common modes of fixation failure. MethodsA retrospective review of 49 patients who underwent fixation via the specific construct at a single institution between 2013 and 2019. ResultsMedian follow-up was 52.7 weeks (Mean: 75.4 weeks; SD: 54.9; range: 27–267.7 weeks). Construct failure rate was 6.1% (3/49). This included two mechanical hardware failures, one the result of trauma and the other due to noncompliance. ConclusionsThe modified construct represents a safe and effective means of treating transverse patella fractures. Level of evidenceLevel 4.

Functional outcome among patients treated by percutaneous cannulated screw with tension band for transverse patella fracture

Introduction: Tension band wiring is the most commonly used treatment method for transverse patella fracture. Tension band construct can be achieved by various modifications. Percutaneous cannulated screw with tension band is a minimally invasive technique with stiffer fixation that follows tension band principle. This study aims to assess the clinical and radiological outcome using percutaneous cannulated screw with tension band for the management of transverse patella fracture. Methods: This was a prospective study among 30 adult patients who had closed displaced transverse patella fracture. Patients with polytrauma, comminuted fracture, neurovascular injury and prior injury to the limb were excluded from the study. Each patient was followed up at 2 weeks, 4 weeks, 3 months and 6 months postoperatively. Results: Among all surgically treated patients using this technique, Pain gradually decreased over time and was less than VAS score of 1 in all patients at 6 months follow-up with an average score of 0.3. The final range of motion at 6 months was: flexion ranging from 122 to 145 degrees and extension lag from of 0 to 8 degrees. There was significant improvement in range of motion of knee in each follow up. The mean duration for fracture union was 11.4±2.3 weeks. There were no cases of nonunion and hardware failure. The mean Lyshom score was 82.5 at final follow up. Conclusions: The percutaneous fixation of transverse patella fracture with cannulated screw and SS wire is safe and effective method which gives good functional outcome.

Radiographic Outcomes Following the Suture Fixation of Mid-pole Patellar Fractures

BackgroundMid-pole patellar fractures are typically fixed with metal implants in the conventional “11-8” tension band construct. However, this technique is fraught with numerous implant-related complications. The aim of this study is to evaluate the union rate following “all-suture” fixation of mid-pole patellar fractures.MethodsWe retrospectively evaluated a consecutive case series of patients with displaced mid-pole patella fractures treated with “all-suture” fixation in our institution. Fifteen cases were available for this study. The average age was 61.5 years. Clinical and radiological outcomes were evaluated. Union time, complications, and revision rate were recorded. The minimum follow-up was one year.ResultsThere were eight males and seven females, with a mean age of 61.5 ± 13.3 years. Fourteen out of 15 cases (93.3%) achieved radiographic union at 12 weeks postoperatively. The average time to radiographic union was 8.0 ± 2.7 weeks. Five cases (33.3%) had an increase in the fracture gap (>2 mm) at around four to six weeks postoperatively. Four of these cases had an eventual union, whereas one patient had fibrous non-union. There was one case of superficial surgical site infection and one case of infected hematoma. None of the patients required revision surgery.Conclusion“All-suture” fixation of mid-pole transverse patellar fractures is a safe and viable alternative to the conventional “11-8” tension band constructs with metal implants, with good union time, rates, and added benefits of not requiring additional surgery for implant removal.

Low-Profile, Suture Anchor Tension Band Construct for Olecranon Fractures and Osteotomies

Olecranon fractures are common and frequently require surgical intervention when they are displaced or unstable. Treatment is largely dictated by fracture type and surgeon preference. Traditional methods of fixation, including tension band wiring and locking plate fixation, have adequate union rates; however, both techniques are associated with increased reoperation rates due to symptomatic hardware. The aim of this article is to describe a technique using a low-profile, suture anchor tension band construct for simple transverse olecranon fractures, triceps avulsions, and olecranon osteotomies. The goal of this technique is to produce stable fixation and allow early range of motion while mitigating the reoperation rate caused by symptomatic or prominent hardware with olecranon plate fixation during fracture and olecranon osteotomies.

A retrospective cohort study on prevalence of postoperative complications in comminuted patellar fractures: comparisons among stabilized with Cannulated-Screw, Kirschner-Wire, or Ring-Pin Tension Bands

BackgroundDisplaced patellar fractures are commonly treated with open reduction and fixation with several different types of tension-band (TB) constructs. The main objective of this study was to compare the prevalence of postoperative complications after surgical stabilization of comminuted patellar fractures with either a modified Kirschner-wire tension band (MKTB), a cannulated-screw tension band (CSTB), or a ring-pin tension band (RPTB).MethodsWe conducted a retrospective and consecutive cohort study of comminuted patellar fractures (n = 334) stabilized using a TB construct. Postoperative premature loss of reduction, infection, and skin breakdown were compared according to the type of TB constructs received (MKTB, CSTB, or RPTB). The rate of implant removal due to symptomatic hardware was also evaluated.ResultsFixation failure rate was significantly different among the groups (P = 0.013), with failure rates of 4.7% observed in the MKTB group,14.5% in the CSTB group, and 4.9% in the RPTB group. Skin breakdown and infection were not significantly different among the groups (Ps > 0.05). Due to symptomatic hardware, 40.5% of the patients in the MKTB group, 22.9% in the CSTB group, and 24.3% in the RPTB group underwent implant removal (P = 0.004). After adjusting for age, gender, comorbidities, number of supplementary screws/K-wires, and use of cerclage cables, multivariate regression analysis revealed that CSTB contributed to a 2.08-times greater risk of fixation failure compared to RPTB, while MKTB and RPTB were similar in risk of failure. In addition, it was found that patients who underwent MKTB fixation were more than twice as likely to undergo implant removal for symptomatic hardware compared with RPTB (odds ratio = 2.11, 95% CI = 1.20 to 3.72; P = 0.010).ConclusionsRPTB have advantage over MKTB and CSTB fixation in terms of symptomatic hardware and premature failure, respectively.Level of evidenceTherapeutic Level III

Tibialis Anterior Tendon Partial Release and Plantar Implant Placement for Midfoot Arthrodesis: Technique Tip

Category:Midfoot/Forefoot; OtherIntroduction/Purpose:Midfoot arthrodesis is a reliable procedure for deformity correction and pain relief. First tarsometatarsal arthrodesis can be used for correction of hallux valgus deformity with large intermetatarsal angles or first-ray hypermobility. Midfoot arthrodesis is also integral in correction of pes planovalgus deformity with midfoot collapse. First tarsometatarsal arthrodesis has a nonunion rate of 2-15%. Arthrodesis is completed traditionally through a dorsal approach. Due to high nonunion rates, recent studies have investigated plater based plates. These have been shown to have superior strength by creating a tension band construct as the foot is loaded. Tibialis anterior footprint is at risk when accessing first tarsometatarsal joint for arthrodesis. We explore whether the tibialis insertional footprint can be released and repaired with no deleterious effects.Methods:Patients included were undergoing first tarsometatarsal joint or naviculocuneiform joint arthrodesis with a plantar based plate and screw construct for hallux valgus deformity with large intermetatarsal angle or first-ray hypermobility, and those with first TMT joint arthritis, pes planovalgus, Lisfranc injury, or Charcot neuroarthropathy. Medial based surgical approach is centered over the first tarsometatarsal joint. Saphenous neurovascular bundle is retracted dorsally. Release of the capsular structures allowed for complete visualization and distraction of the joint. The distal-most attachment of the tibialis anterior tendon onto the first metatarsal is release in line with the capsulotomy. Primary insertion on the medial cuneiform was preserved. A cuff of released insertional tissue is preserved and reflected distally for repair. Standard tarsometatarsal arthrodesis joint preparation was completed. Plantar plate then fixed and compressed. Deep fascial layers were then closed over the plated were previous tendon release was performed.Results:In 62 patients, none had tibialis anterior tendon rupture, weakness, or irritation, with average follow-up of 36.2 months. Nine wound complications were recognized during the study. Twelve percent of patients experiencing delayed incisional healing that went on to heal with local wound care. Smokers accounted for six of the seven patients (OR 24.62, p<.05), and one of seven patients had Charcot (OR 2.08, p<.05). Deep wound complications, which required return to the operating room for formal irrigation and debridement, were seen in 3% (2 of 62). Both patients were active smokers and had removal of hardware at the time of debridement. Both underwent definitive coverage with split-thickness skin grafts and went on to successful arthrodesis and wound healing.Conclusion:One advantage of applying a plate and screw construct plantarly for midfoot arthrodesis is biomechanical stability. Multiple studies have indicated this plantar construct may be superior. Another benefit may be less hardware prominence due to increased soft-tissue coverage. Subcutaneous positions of dorsal plates have been reported to contribute to incisional irritation and symptomatic hardware. Tibialis anterior tendon damage has been suggested as a limitation of the plantar approach for midfoot arthrodesis, and the tendon insertion must be released to prepare the joint adequately to apply implants. This series shows tendon release can be safely accomplished without any deleterious effects.

Augmented intramedullary screw tension band construct for olecranon fracture reduction and fixation: a review of literature and surgical technique

Olecranon fractures, which make up 10% of upper extremity fractures in adults, often require anatomic reduction and stable internal fixation. Successful olecranon fracture osteosynthesis has classically been achieved via tension band wiring or plate fixation. This article reviews the indications, outcomes, and a surgical technique as an alternative construct for tension band wiring of olecranon fractures. The technique involves placement of an ulnar intramedullary partially threaded screw that is used as a proximal point of attachment for tension band wiring of the olecranon. Although infrequently used by orthopedic surgeons, this construct has been shown to be biomechanically and clinically superior to classic Kirschner wire tension banding techniques. This review is intended to familiarize surgeons with a surgical technique that can be applied to a variety of proximal ulna fractures.

Influence of wire configuration on resistance to fragment distraction of tension bands placed in a greater trochanteric osteotomy model.

To determine the influence of wiring configurations on initial tension and resistance to tensile loads in tension band constructs without the contributions of Kirschner-wire stabilization. Experimental study. A solid brass femur model manufactured on the basis of computed tomography of a normal right femur of a 30-kg dog modified by transection of the greater trochanter and placement of two pins that did not cross the simulated osteotomy. Four tension band configurations were applied to the metal trochanteric osteotomy model: figure-of-eight with one twist (OT), figure-of-eight with two twists (TT), dual interlocking single loop, and double loop (DL). Configurations were tested under both monotonic loading (n = 8 per configuration) and incremental cyclic loading (n = 8 per configuration). Initial tension after tying, residual tension remaining after each cycle, and failure load at 2 mm of displacement (considered equivalent to clinical failure) were compared between configurations. The initial tension and the load to 2 mm of displacement were lower for OT wires compared with TT wires. The DL was the strongest and most stable configuration, generating 2.3 to 3.5 times greater initial tension, maintaining a greater percentage of residual tension under incremental cyclic loads, and resisting 2.0 to 2.4 times greater load before failure at 2 mm. Failure load was highly correlated with initial tension. Wire configurations reaching greater initial tension, such as the DL, allowed constructs to resist higher tensile loads. Wire configurations allowing higher initial tension may be warranted when tension bands are expected to sustain high tensile loads.

Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

Category:BunionIntroduction/Purpose:Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing.Methods:The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA.Results:There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up.Conclusion:This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

Management of patella fractures with different modalities

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Patella fracture is quite a common injury for all ages of patients, constituting approximately 1% of all skeletal injuries. Patella is the largest sesamoid bone in the body. The aim of study was to assess the functional outcome of patella fractures treated with modified tension band wiring using K wires and cannulated cancellous screws with tension band construct.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was a prospective clinical study to be conducted at the Department of Orthopaedic Surgery, Chalameda Anand Rao Institute of Medical Sciences, Karimnagar from October 2016 to November 2018. Total, 20 patients with transverse patellar fractures were studied and divided into 2 groups according to the surgical technique: 10 patients were in the MKTB group and 10 patients in the CSTB group.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 20 patella fractures were included in this study.&lt;strong&gt; &lt;/strong&gt;The Bostman’s score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We conclude that compared with the MKTB technique, CSTB fixation is an effective surgical procedure for treatment of displaced transverse patellar fractures.&lt;/p&gt;

Biomechanical Comparison of Olecranon Sled Versus Intramedullary Screw Tension Banding for Olecranon Osteotomies.

Background:Olecranon osteotomies are frequently performed to gain access to the distal humeral articular surface. Repair of the osteotomy or fixation of a simple 2-part olecranon fracture with traditional tension band construct is often plagued by complication. Proximal migration and irritation attributed to hardware are common complications of the standard construct of an intramedullary screw with tension band and are causes for reoperation.Purpose:To compare the biomechanical performance, time of implant, and prominence of an intramedullary screw and tension band construct with that of a newer low-profile continuous loop tension band (Olecranon Sled) construct in an olecranon osteotomy model.Study Design:Controlled laboratory study.Methods:Chevron osteotomies were created in 6 matched pairs of fresh-frozen human elbows (mean age, 66 ± 16 years). Each matched pair was then randomly divided into 1 of 2 groups: fixation with a screw and tension band construct or the Olecranon Sled. Bone mineral density, implant prominence, and time for implantation were recorded. Following olecranon fixation, each specimen underwent cyclic loading of 0 to 10 N for 100 cycles (to simulate unresisted active range of motion) and then 0 to 500 N for 500 cycles (to simulate pushing up from a chair) to measure for any displacement at the osteotomy site. The constructs were then loaded to failure and compared.Results:No differences were found in bone mineral density between the 2 groups (P = .290). When measured from the tip of the olecranon, the continuous loop tension band had a medial prominence of only 3.57 ± 0.4 mm, as opposed to the intramedullary screw fixation of 7.288 ± 0.762 mm (P = .027). Total time of implantation, including osteotomy preparation, was a mean 155 seconds shorter with the Olecranon Sled versus the traditional tension band (P < .05). Because of the fracture of 1 specimen during cyclic loading, it and its matched counterpart were excluded, and only 5 matched pairs were analyzed for displacement and load to failure. There were no significant differences between groups in load to failure or displacement during cyclic loading (P > .05).Conclusion:The Olecranon Sled device was found to have no difference in biomechanical strength from that of the standard intramedullary screw with tension band construct. The Olecranon Sled was also found to be significantly less prominent while being faster to implant than the intramedullary screw.Clinical Relevance:Evaluating an alternative option to the standard tension band construct is important for patients with olecranon fractures or osteotomies, as standard techniques have been fraught with hardware issues and need for revision surgery.

Treatment of Patella Fractures.

Patella fractures comprise 1% of all fractures. Treatment options vary based on fracture displacement, classification, and patient factors. Traditionally, nonoperative treatment has been reserved for nondisplaced fractures. Many operative treatments are available with differing indications and levels of success. Tension band constructs have been the most commonly employed approach to fixation, with cerclage wiring for comminuted fractures. Recently, plate fixation of patella fractures has become more popular. Plating constructs offer a low-profile design with stable fixation, allowing for earlier mobilization and potentially improved functional outcomes. Data regarding the long-term outcomes of plating techniques are limited, and further studies are needed. [Orthopedics. 2018; 41(6):e747-e755.].