Tension Band Suture Research Articles

Comparison of biodegradable and metallic tension-band fixation for paediatric lateral condyle fracture of the elbow

IntroductionIn our retrospective study we compared the outcomes of paediatric lateral condyle fractures of the elbow fixed by bioabsorbable pins and tension-band sutures or by metallic tension-band with K-wires. Materials and methodsWe reviewed the data of children operated on for lateral condyle fractures between 2010 and 2020. Patients were classified as follows: 1. fractures treated with metallic (KW group), 2. fractures treated with resorbable implants (BR group). We compared the distribution of age, sex and fracture type in each group. Operative times of the two techniques were also recorded and compared. We analysed the X-rays taken one year after the injury and measured the following parameters: presence of possible non-union, varus or valgus deviation, lateral spur formation. Patients whose follow-up period was less than one year were excluded. For categorical data, group comparisons were performed with Chi-square test or Fisher's exact test, depending on the sample size. The evaluation of discrete variables was performed with Mann-Whitney U test. Results42 patients met the above criteria. We found 19 children in the Kirschner -wire + tansion band wire (KW) group and 23 in the Bioresorbable pin + tension band suture (BR) group. There were no significant differences between the study groups in terms of age, sex, left-right ratio, number of complications, operation time, number of Jacobs II and III cases or follow-up time. The operation time was on average 5 min longer in the bioresorbable group (K-wire mean = 62.1 min, Bioresorbable mean = 67 min), this difference, however, is not statistically significant (P = 0.177). In terms of minor and major complications, there was no statistically significant difference between the two groups. (P = 0.729). ConclusionsWe did not notice any difference between the complication rates of the two methods, so the real advantage of the absorbable implant technique is that no second intervention is necessary.The benefits of using biodegradable implants in various osteosynthesis techniques need further confirmation by randomised trials.

Finger Pulp Injuries Treated With Needle And Figure Of 8 Suturing

Background: injuries to the finger pulp are encountered in occupational, household work and rta.in the present study, fingertip injuries were treated by reducing the fracture fragments, repositioning the nail plate in the nail fold, and securing it with the needle vertical figure of eight tension band sutures. Objective: to know the clinical outcomes of finger pulp injuries treated with 23g needle fixation and figure of 8 suturing. Methodology: 15 patients were included in the study. The study was done at chennai, tamil nadu, a.c.s. Medical college and hospital on patients with finger pulp injuries in casualty as an outpatient. This interventional study was done for 12 months. All patients were followed up for 6 months. Results: most of the patients were aged above 18. Most of the patients were males. The thumb finger was most commonly involved. The right side is more commonly affected. All patients were given antibiotics orally for 2 weeks. Fracture healing happened in 6 weeks for most of the patients. Union was achieved in 8 to 9 weeks for most of the patients. Conclusion: using an 23g needle instead of k-wire fixation for treating associated fractures of the distal phalanx has enhanced versatility and yielded good outcomes. This approach also circumvents the formal repair of the nail bed, promoting smooth healing of the injury

Clinical and radiographic outcome of tension band suture fixation for displaced olecranon fractures

BackgroundTension band wire fixation (TBW) is a well-described method for treating displaced olecranon fractures. Further surgery is often needed due to wound breakdown or prominent hardware. An all-suture technique has recently been described as an alternative to TBW but radiographic and clinical outcome are not well established. The aim of this single-center retrospective cohort study was to evaluate outcome after treatment with all-suture technique for simple displaced olecranon fractures.MethodsA retrospective review of olecranon fractures in patients (> 18 years) treated for displaced olecranon fractures with tension band suture fixation (TBSF) between February and August 2019 was performed in our facility. Primary outcome was revision surgery, which was assessed four years after surgery. Clinical and radiographical follow-up was performed at two weeks, six weeks, three months and six months to assess union rate, fracture displacement, range of motion (ROM), Quick-DASH and Oxford Elbow Score.ResultsA total of 24 patients were included. Median age was 64 years [IQR:39–73], 9 patients were male and median ASA score was 2 [IQR:1–2]. 15 fractures were Mayo type 2 A and 9 type 2B with minor comminution. At four-year follow-up, three patients had died. None of the remaining 21 patients had undergone revision surgery. At six months, the median Quick-DASH and Oxford Elbow Score were 2.3 [IQR:0-4.5] and 47 [IQR:46–48], respectively. Median elbow extension and flexion deficits were 0° [IQR:0-2.25] and 0° [IQR:0–0], respectively. Radiographic union was achieved in all patients. In two cases radiographic loss of reduction and malunion was observed but both patients were asymptomatic and had no functional deficits. One patient refractured the elbow due to a second trauma and was reoperated.ConclusionsTBSF is a promising technique for Mayo type 2 A and 2B fractures with minor comminution. There were no revision surgeries within the first four years. We found good functional outcomes and a high union rate.

A Surgical Technique for Tibial Tubercle Avulsion Fractures Using Transpatellar Suture Tape Tension Band and De-tensioning Suture Anchors

This article aims to present a comprehensive technical note detailing our preferred treatment approach for tibial tuberosity avulsion fractures in the adult and elderly populations, particularly in scenarios characterized by low tissue quality and limited bone stock. Existing literature on this fracture type is scarce, with many described techniques relying on optimal bone quality for effective screw fixation of the tibial tuberosity. Various methods for tibial tuberosity avulsion fixation include K-wires, cannulated screws, staples, tension bands, suture anchors, and in select cases, direct transosseous sutures. Our technique focuses on robustly supporting the extensor mechanism through a synergistic combination of de-tensioning suture anchors, tension band suture taping, and suture augmentation of the patellar tendon. This approach addresses the challenges posed by compromised tissue quality and limited bone stock, offering a valuable contribution to the management of these fractures.

Sagittal Synostectomy With Tension Band Sutures for Correction of Sagittal Craniosynostosis.

Premature fusion of the sagittal suture is the most common form of craniosynostosis and can be treated using a variety of open or endoscopic approaches. Existing approaches have varying degrees of effectiveness. Open approaches, whether performed early or late, can be associated with significant blood loss and the need for transfusion. Endoscope-assisted approaches are minimally invasive but require months of postoperative helmet therapy to help remodel the skull. Implantation of springs or distractors requires a second operation for removal of the devices. Here, we present an alternative technique for early correction of sagittal craniosynostosis combining sagittal synostectomy with tension band sutures to remodel the skull without need for transfusion or helmet therapy. We retrospectively reviewed the medical records of all patients treated for sagittal craniosynostosis using a synostectomy with tension band sutures at a single tertiary care institution. Data on patient demographics, operative factors, and postoperative course were collected. Thirty-four patients underwent the novel procedure. The median preoperative cephalic index was 68 and improved to 76 immediately postoperatively. The median blood loss was 10 mL while the operative duration was 112 minutes. No blood transfusions were needed. One small dural laceration was encountered that was promptly repaired. There were no postoperative complications. Patients presenting for follow-up visits showed continued improvement in head shape and cephalic index. A modified sagittal craniectomy with tension band sutures to remodel the skull is effective in achieving immediate correction of sagittal craniosynostosis. The correction remains durable over long-term follow-up. Importantly, the technique can be performed with minimal blood loss and reduces transfusion risk, operative time, and overall morbidity compared with traditional open approaches while avoiding the need for helmet therapy necessitated by endoscopic approaches.

Biomechanical comparison of tension band suture fixation and tension band wiring in olecranon fractures

PurposeTraditional tension band wire fixation (TBWF) of olecranon fractures is associated with high revision rates due to implant-related complications. The purpose of the study was to compare the strength of fixation in olecranon fractures between TBWF and an all-suture based technique. MethodsA transverse fracture was created in 20 paired fresh-frozen human cadaveric elbows. Fractures were randomly (alternating right-left) assigned for fixation with either tension band suture fixation (TBSF) or TBWF. The elbow was fixed in 90° of flexion and underwent cycling loading by pulling the triceps tendon to 300 N for 200 cycles. Fracture displacement was optically recorded using digital image correlation (DIC). Finally, load-to-failure was assessed by a monotonic pull to 1000 N and failure mechanism was recorded. ResultsTwo specimens in the TBSF group were excluded from the cycling loading analysis due to technical difficulties with the DIC. After cyclic loading, median (min-max) fracture displacement was 0.28 mm (0.10–0.44) in the TBSF group and 0.18 mm (0.00–1.48) in the TBWF group (p = 0.315). No difference was found between the two groups in the repeated measures analysis of variance (p = 0.329). In the load-to-failure test, 6/10 specimens failed in the TBSF group (median load-to-failure 791 N) vs. 8/10 in the TBWF group (median load-to-failure 747 N). The TBSF constructs failed due to fracture of the dorsal cortex, suture breakage or triceps failure. The TBWF constructs failed due to breakage of the wire. ConclusionThere was no difference in fixation strength between the TBWF and TBSF constructs. Our findings suggest TBSF to be a feasible alternative to TBWF and we hypothesize that a non-metallic implant may have fewer implant-related complications. Level of evidenceBasic science study

Biomechanical Evaluation of Transverse Patella Fracture Fixation using Headless Screws: A Comparison of Suture vs. Cable as a Tension Band.

To explore the performance of headless screws with FiberWire Suture as a tension band and headless screws with a mini-cable tension band in patella fixation. A transverse osteotomy was created in six matched pairs of fresh-frozen cadaver knee joints. One knee was randomly assigned to receive fixation with headless screws plus a cable tension band (Synthes 1.3 mm cable with crimp), while the other was fixed with headless screws plus a suture tension band (#5 FiberWire). Using a servo-hydraulic material testing system, the specimens were first tested non-destructively under 20% of the reported mean failure load with standard technique of cannulated screws with tension band wiring. The specimen was then loaded to 1000 N to test the construct's failure strength. All tests were run under displacement-control with loading threshold. A motion analysis system was used to track the interfragmentary motion to assess fixation stability. The correlation between fixation strength and score of bone density was also examined. In the non-destructive loading test, gap displacement under 150N was 0.10 mm or less for 11 of 12 specimens, and the difference between the two groups was not statistically significant. In the destructive test, 3 of 12 specimens maintained reduction (gap<2mm) at the maximum load of 1000 N. Of the failed specimens, the mean strength was 648±185 N for suture and 784±228 N for cable (p=0.24). Regression analysis shows bone density was associated with the failure load of the tendon (R2=0.43, p=0.02). There was no significant difference in fixation strength or sub-failure fragment displacement between the suture and cable tension band techniques when using headless screws, but suture on average was weaker.

A randomized controlled trial to compare clinical and cost-effectiveness of suture fixation versus tension band wiring for simple olecranon fracture fixation in adults: The Simple Olecranon Fracture Fixation Trial (SOFFT) protocol.

Olecranon fractures are usually caused by falling directly on to the olecranon or following a fall on to an outstretched arm. Displaced fractures of the olecranon with a stable ulnohumeral joint are commonly managed by open reduction and internal fixation. The current predominant method of management of simple displaced fractures with ulnohumeral stability (Mayo grade IIA) in the UK and internationally is a low-cost technique using tension band wiring. Suture or suture anchor techniques have been described with the aim of reducing the hardware related complications and reoperation. An all-suture technique has been developed to fix the fracture using strong synthetic sutures alone. The aim of this trial is to investigate the clinical and cost-effectiveness of tension suture repair versus traditional tension band wiring for the surgical fixation of Mayo grade IIA fractures of the olecranon. SOFFT is a multicentre, pragmatic, two-arm parallel-group, non-inferiority, randomized controlled trial. Participants will be assigned 1:1 to receive either tension suture fixation or tension band wiring. 280 adult participants will be recruited. The primary outcome will be the Disabilities of the Arm, Shoulder and Hand (DASH) score at four months post-randomization. Secondary outcome measures include DASH (at 12, 18, and 24 months), pain, Net Promotor Score (patient satisfaction), EuroQol five-dimension five-level score (EQ-5D-5L), radiological union, complications, elbow range of motion, and re-operations related to the injury or to remove metalwork. An economic evaluation will assess the cost-effectiveness of treatments. There is currently no high-quality evidence comparing the clinical and cost effectiveness of the tension suture repair to the traditional tension band wiring currently offered for the internal fixation of displaced fractures of the olecranon. The Simple Olecranon Fracture Fixation Trial (SOFFT) is a randomized controlled trial with sufficient power and design rigour to provide this evidence for the subtype of Mayo grade IIA fractures.Cite this article: Bone Jt Open2023;4(1):27-37.

The Hybridge Technique: A Combined Technique of Suture Bridge and Tension Band for an Arthroscopic Eco-Responsible Rotator Cuff Repair

Arthroscopic rotator cuff repair is mainly based on 2 proven biomechanical concepts: suture bridge and tension band. This Technical Note describes the use of a combination of these 2 techniques to repair extensive lesions with only 3 anchors. Besides being less expensive, the use of a limited number of anchors is part of a global medicoeconomic and eco-responsible approach to our surgical activities.

Treatment of olecranon fractures in childhood: A systematic review.

Literature over the last 20 years provides evidence for a surgical treatment of displaced olecranon fractures in children, this is usually obtained with commonly proposed methods, although there is no general agreement about the best recommended technique. Identifying the best surgical technique in displaced olecranon fractures in children and the role of associated fractures in the prognosis of these lesions, by analyzing the most relevant studies on this topic. A literature search was performed in MEDLINE database and Scopus database. Articles reporting clinical outcomes of pediatric patients affected by olecranon fractures treated surgically were identified. The initial search produced 111 studies, with 8 fulfilling the eligibility criteria of our study. Selected articles (2002-2022) included 122 patients overall. Displaced olecranon fractures, occurring during skeletal growth and surgically treated, generally have good results, although we are unable to recommend the best surgical treatment based on our review. In most cases, they are intra-articular fractures; thus, the overall goal is to get an anatomic reduction that in some cases cannot be obtained by percutaneous techniques. Tension band suture is the preferred device, although it is not recommended in adolescence for the high risk of fixation failure. Associated lesions may affect results.

Metal Tension-Band Wires vs Tension-Band Sutures in the Fixation of Olecranon Fractures: A Systematic Review

Background: Tension-Band Wiring (TBW) is the treatment of choice for displaced, non-comminuted olecranon fractures. Due to the high complication rate involved with TBW, particularly the need for re-operative hardware removal, an alternate method using a high-strength, non-metallic Tension-Band Suture (TBS) construct has been precipitated. There is currently no literature comparing and evaluating these 2 particular techniques, therefore, this systematic review aims to address this. Methods: 6 databases were searched (MEDLINE, Embase, Web of Science, Cochrane Library, The CRD and Clinicaltrials.gov). Titles, abstracts and full articles were then systematically screened against the eligibility criteria. The primary outcomes studied were reported postoperative functional outcomes, and complication rates. Results: From 2538 identified abstracts, 5 studies met our eligibility criteria. Only one study compared TBW with TBS and concluded that in paediatric patients, there is a lack of benefit from TBS due to a similar rate of reoperation for hardware removal. 4 studies solely analysed TBW. In TBW, the rate of reoperation reached as high as 76.5% with the need for hardware removal being the most common indication. Conclusion: This review was required to highlight the alarming paucity of studies analysing TBS fixation in the treatment of non-comminuted olecranon fractures. Based on the included studies, it is difficult to conclude an advantage for either TBW or TBS due to the lack of standardised measuring of functional outcomes and comparative studies. There is potential for a reduced rate of reoperation in TBS, however, there is a great need for more robust studies analysing this technique.

Suture tension band fixation vs. metallic tension band wiring for patella fractures – A biomechanical study on 19 human cadaveric patellae

PurposeTraditional tension band fixation of patella fracture is associated with high reoperation rates. The purpose of the study was to assess strength of fixation in patella fractures treated with either a non-metallic all suture-based technique or traditional metallic tension band wiring. MethodsTen paired human cadaveric specimens were included. A transverse fracture was created, reduced and fixated with a non-metallic or metallic approach. Non-metallic fixation was done according to a previously published technique, metallic fixation was done according to AO description. Specimens were fixed in 90° of flexion and underwent 200 cycles of loading by pulling the Quadriceps tendon to 300 Newton. Fracture displacement was optically monitored. Primary outcome was fracture displacement after 200 cycles compared to the first cycle. Subsequently, load-to-failure was assessed by a monotonic pull to 1000 N. ResultsFor cyclic loading analysis, one specimen from each group was excluded due to machine synchronization, resulting in a total population of 18 specimens. Median (min-max) fracture displacement was 0.65 mm (0.06-1.3) in the non-metallic group and 0.68 mm (0-1.23), (p=0.931) in the metallic group. No difference in displacement was found between the two groups in the repeated measures analysis of variance (p=0.5524). For load-to-failure analysis one specimen was excluded due to machine synchronization, resulting a total population of 19 specimens. 2/9 specimens failed in the non-metallic group (at 979 and 635 N) and 2/10 failed in the metallic group (745 and 654 N). ConclusionNon-metallic technique is a biomechanically viable alternative to traditional tension band fixation and it can hopefully lead to fewer implant-related complications.

Olecranon fractures: applied anatomy, clinical assessment and evidence-based management.

Olecranon fractures are common injuries, making up 10% of all fractures of the upper limb. They usually result from a fall from standing height in older people, or from a direct blow in young people. The olecranon's superficial location, with poor soft tissue and muscle protection, make it liable to fracture following direct impact. Factors such as the degree of initial force and the quality of the patient's bone result in a range of injury patterns, from simple undisplaced fractures to complex open fracture dislocations. In the context of high energy trauma, the patient should first be assessed for life-threatening injuries. A thorough history and clinical examination including neurovascular assessment should then be completed. Antero-posterior and lateral X-rays are sufficient to confirm the diagnosis. Initial management includes immobilisation in an above elbow backslab, a sling and analgesia. Owing to the pull of the triceps muscle which attaches to the tip of the olecranon, fracture displacement is common and surgical intervention is often required, usually with good outcomes. Surgical techniques include tension band wiring, open reduction internal fixation with a pre-contoured locking plate and tension band suture fixation. Undisplaced fractures or displaced fractures in older patients can be managed conservatively with an above elbow cast for 4 weeks. This article covers applied anatomy, initial presentation, clinical assessment and evidence-based management.

Comparison of double-strand braided polyester sutures tension band (Nice knot) with cable tension band in transverse patellar fractures

BackgroundThe tension band technique is the most common method for internal fixation of transverse patellar fractures. Titanium cable and high-strength sutures have been successfully applied in this treatment; however, few studies have compared the Nice knot technique using sutures with the standard cable technique. Whether the suture technique (Nice knot) provides preferable results compared with those of the cable technique is unclear. MethodsForty patients with transverse patellar fractures participated in this study. Twenty patients underwent sutures tension band fixation (Nice knot), and the others were managed with cable tension bands. All patients were followed up at 1, 3, 6, and 12 months. Pain was measured by VAS scores, flexion and extension of the knee were measured in degrees by goniometry, and knee function was evaluated using the Böstman clinical grading scale. ResultsThe two groups had equal distributions in age, gender, injured side, and fracture classification. The mean operation time in the suture group was shorter (55.75±9.77 minutes versus 64.25±9.63 minutes). The VAS score was comparable in the two groups at the 1-month, 3-month, and 6-month follow-ups; however, the score was lower at 12 months postoperatively in the suture group (P=0.037). No significant difference was found in flexion, extension, Böstman score, or fracture healing time in either group (P>0.05). Postoperative complications were higher in the cable group (9 versus 2) (P = 0.031) but were mostly related to symptomatic soft tissue irritation. ConclusionThe suture tension band technique using braided polyester nonabsorbable sutures tied with Nice knot was as effective as the cable tension band technique for transverse patellar fracture management. However, more convenient operations, less cost and fewer complications were found in suture fixation (Nice knot).

Patella fractures treated with suture tension band fixation

BackgroundPatella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures.MethodsThis technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution.ResultsThis technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material.ConclusionsWe believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

Interventions for treating fractures of the patella in adults.

Fractures of the patella (kneecap) account for around 1% of all human fractures. The treatment of these fractures can be surgical or conservative (such as immobilisation with a cast or brace). There are many different surgical and conservative interventions for treating fractures of the patella in adults. This is an update of a Cochrane Review first published in 2015. To assess the effects (benefits and harms) of interventions (surgical and conservative) for treating fractures of the patella in adults. We searched CENTRAL (2020, Issue 1), MEDLINE, Embase, LILACS, trial registers and references lists of articles to January 2020. We included randomised controlled trials (RCTs) or quasi-RCTs that evaluated any surgical or conservative intervention for treating adults with fractures of the patella. The primary outcomes were patient-rated knee function, knee pain and major adverse outcomes. At least two review authors independently selected eligible trials, assessed risk of bias and cross-checked data extraction. Where appropriate, we pooled results of comparable trials. We included 11 small trials involving 564 adults (aged 16 to 76 years) with patella fractures. There were 340 men and 212 women; the gender of 12 participants was not reported. Seven trials were conducted in China and one each in Finland, Mexico,Pakistan and Turkey. All 11 trials compared different surgical interventions for patella fractures. All trials had design flaws, such as lack of assessor blinding, which put them at high risk of bias, potentially limiting the reliability of their findings. No trial reported on health-related quality of life, return to previous activity or cosmetic appearance. The trials tested one of seven comparisons. In the following, we report those of the main outcomes for which evidence was available for the three most important comparisons. Four trials (174 participants) compared percutaneous osteosynthesis versus open surgery. Very low-quality evidence means that we are uncertain of the findings of no clinically important difference between the two interventions in patient-rated knee function at 12 months (1 study, 50 participants) or in knee pain at intermediate-term follow-up at eight weeks to three months. Furthermore, very low-quality evidence means we are uncertain whether, compared with open surgery, percutaneous fixation surgery reduces the incidence of major adverse outcomes, such as loss of reduction and hardware complications, or results in better observer-rated knee function scores. Two trials (112 participants) compared cable pin system (open or percutaneous surgery) versus tension band technique. The very low-quality evidence means we are uncertain of the findings at one year in favour of the cable pin system of slightly better patient-rated knee function, fewer adverse events and slightly better observer-rated measures of knee function. There was very low-quality evidence of little clinically important between-group difference in knee pain at three months. Very low-quality evidence from two small trials (47 participants) means that we are uncertain of the findings of little difference between biodegradable versus metallic implants at two-year follow-up in the numbers of participants with occasional knee pain, incurring adverse events or with reduced knee motion. There was very low-quality and incomplete evidence from single trials for four other comparisons. This means we are uncertain of the results of one trial (28 participants) that compared patellectomy with advancement of vastus medialis obliquus surgery with simple patellectomy; of one quasi-RCT (56 participants) that compared a new intraoperative reduction technique compared with a standard technique; of one quasi-RCT (65 participants) that compared a modified tension band technique versus the conventional AO tension band wiring (TBW) technique; and of one trial (57 participants) that compared adjustable patella claws and absorbable suture versus Kirschner wire tension band. There is very limited evidence from nine RCTs and two quasi-RCTs on the relative effects of different surgical interventions for treating fractures of the patella in adults. There is no evidence from trials evaluating the relative effects of surgical versus conservative treatment or different types of conservative interventions. Given the very low-quality evidence, we are uncertain whether methods of percutaneous osteosynthesis give better results than conventional open surgery; whether cable pin system (open or percutaneous surgery) gives better results than the tension band technique; and whether biodegradable implants are better than metallic implants for displaced patellar fractures. Further randomised trials are needed, but, to optimise research effort, these should be preceded by research that aims to identify priority questions.

Results of vertical figure-of-eight tension band suture for fingernail disruption with fractures of distal phalanx.

To give painless and stable fingertips to patients by means of vertical figure-of-eight tension sutures. The longitudinal study was carried out from May to October 2019 at the Dow University of Health Science, Civil Hospital, Karachi, and comprised individuals of either gender aged 10-60 years. All patients were surgically managed and were assessed clinically and with radiological films for finger stability and fracture healing during 3-month follow-up. Data was collected using a proforma and was analysed using SPSS 21. Of the 74 patients, 58(78.4%) were males and 16(21.6%) were females. The overall mean age was 28.9±13.23 years. Of the total, 65(88%) were operated under local anaesthesia, while 9(12%) were given general anaesthesia. All 74(100%) patients on early visits had pain and discomfort, 5(6.8%) had infection and none had ischaemic insult. Using vertical figure-of-eight tension sutures was found to be a simple technique which helped in proper healing of distal phalanx fractures and a non-deformed fingertip.

Treatment of olecranon fractures using an intramedullary cancellous screw and suture tension band: minimum 2-year follow-up

Tension band wiring and plates are the most widely used treatments for transverse displaced fractures of olecranon despite high rates of hardware complications, subsequent implant removal, and associated costs. The purpose of this study was to report the outcomes of displaced transverse olecranon fractures treated with intramedullary screw and suture tension band. We performed an observational, retrospective, consecutive, monocentric, continuous multioperator study. We reviewed 31 Mayo type IIA displaced olecranon fractures treated in our institution with intramedullary 6.5 mm AO cancellous screw and high-strength suture tension band (No. 2 FiberWire®) from 2016 to 2018. Inclusion was limited to functionally independent patients with Mayo type IIA fractures and minimum 24-month follow-up for implant removal. We assessed clinical outcomes including range of motion; QuickDASH score; and Mayo Elbow Performance Score. Categorical data were analyzed with Fisher's exact test when appropriate. Continuous data were analyzed with the Student t-test or Mann-Whitney U test after assessment for normality. Statistical analysis was performed with STATA 16 software. Twenty-seven patients with a mean follow-up period of 38.4 ± 6.2 months (range, 24.1-50 months) were included in the study. The average flexion was 134.5° ± 14.8° (range, 70°-140°) and the mean extension was-5.9° ± 7.0° (range,-20°-0°). Mean pronation and supination were 85.8° ± 11.9° (range, 45°-90°) and 86.9° ± 14.3° (range, 20°-90°), respectively. The mean Mayo Elbow Performance Score was 90.8 ± 9.6 (range, 70-100) with 92.3% good and excellent results. The mean QuickDASH score was 17.1 ± 16 (range, 0-54.5). There were 3 hardware-related removals (11.1%). The overall removal rate was 18.5%. Univariate analysis of the factors associated with implant removal were pain in relation to the implant (60% vs. 11%, P = 0.0482), proximal screw migration (3.7 mm vs. 1.7 mm, P= 0.05), articular angle (22.5° vs. 27.7°, P= 0.0353), and olecranon width (22.2 mm vs. 24.4 mm, P= 0.0166). In total, 26.1% of the cases presented some degree of proximal migration of the implant (2.7 ± 1.8 mm of migration; range, 1.5-6.2 mm). Univariate analysis of the factors associated with implant proximal migration were proximal ulnar dorsal angulation (1.7° vs. 6.4°, P= 0.0179), anteroposterior endomedullary canal (7.3 mm vs. 6.0 mm, P= 0.0369), and lateral endomedullary canal (7.2 mm vs. 5.0 mm, P= 0.0219). The functional outcomes of simple transverse olecranon fractures treated with an intramedullary cancellous screw and a suture tension band are excellent, associated with a low rate of complications and material removal.

In vitro evaluation of the tension band suture method for proximal humerus fracture treatment

BackgroundProximal humeral fractures are common, and more than half occur in patients over 65 years of age. Operative treatment may be recommended for displaced, complicated fractures; however, surgery may lead to displacement of the greater tuberosity or humeral head. Supplemental tension band sutures have been recommended to prevent such a complication. In this study, we investigate the best combination of suture, washer, and threading angle for proximal humeral fractures from a mechanical view.MethodsThe mechanical durability of 18 combinations of suture materials (Fiberwire, Ethibond, and Surgilon), threading washers (ring washer, disc washer), and threading angles (15 or 45°) were examined via a cyclic loading test.ResultsThe most durable combination in the cyclic loading test consisted of threading the Fiber Wire to the washer ring using only one hole (ring washer-1) at 45°. In contrast, the most vulnerable combination was threading Ethibond to the washer disc at 15°. Breakage of all suture materials occurred at the suture-washer interface, and no failure or loosening of the knots was observed. FiberWire gradually eroded until the loss of equilibrium; whereas the rupture of Ethibond and Surgilon occurred suddenly.ConclusionsFrom a mechanical viewpoint, we demonstrated that applying a supplemental tension band suture using FiberWire with a single-hole ring washer threaded at a wider angle is recommended.

Olecranon fractures in children and adolescents: outcomes based on fracture fixation.

:PurposeOpen reduction and internal fixation with a tension band construct is the standard treatment for displaced transverse intra-articular olecranon fractures. The purpose of this study is to describe the outcomes of tension band fixation of olecranon fractures in children, specifically assessing the need for revision fixation and hardware removal.MethodsPatients less than 18 years of age diagnosed with a displaced transverse intra-articular olecranon fracture and treated with tension band fixation between 2008 and 2017 were retrospectively enrolled. Operative treatment was with tension band wire (TBW) or tension band suture (TBS) constructs.ResultsA total of 46 patients, 36 male and ten female with a mean age of 12.3 years (6 to 17), were included. Surgical fixation was with TBW in 17 patients and TBS in 29 patients. Revision fixation due to failure and fracture displacement was required in 6% of the TBW group and 14% of the TBS group (p = 0.19). The patients who required revision fixation in the TBS group were older (14.7 years versus 11.6 years, p = 0.05) and heavier (70.5 kg versus 48.5 kg, p = 0.05) than those in the same group who did not require revision fixation.ConclusionPaediatric olecranon fractures treated with TBW or TBS fixation unite in the majority of patients with similar need for hardware removal due to prominence and/or pain between fixation techniques. In a select group of older patients weighing greater than 50 kg, TBS constructs demonstrate increased failure rates, requiring revision fixation, and should be avoided in this population group.Level of Evidence:IV