Tension Band Suture Research Articles

Tension Band Sutures Using a Washer for a Proximal Humerus Fracture

To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.

Displaced Olecranon Fractures in Children

Wire and suture methods have been used to stabilize pediatric olecranon fractures. This study (1) compared differences in simulated intraoperative compression during fracture reduction, (2) evaluated articular surface compression during cyclic loading of the tension band, and (3) compared fracture stabilization after cyclic physiologic loading at low/high levels. Identical olecranon fractures were created in 10 synthetic ulnae and randomized to suture or wire fixation. Compression after fixation and compression during cyclic loading between 10 and 50 N was measured with a load cell at the articular surface and compared with a 1-way analysis of variance (p < 0.05). Twenty-four fractured synthetic ulna were randomly assigned to wire or suture tension band constructs and low- or high-loading groups. The low-load group (12 ulnae) cycled loading from 3 to 10 N for 100 cycles followed by a failure test. The high-load group (12 ulnae) experienced 10 to 100 N before failure testing. Fracture separation (mm) and failure load (N) were compared using a 2-way analysis of variance (p < 0.05). Ten synthetic ulnae were randomized to wire/suture groups and cyclically loaded between 10 to 50 N while measuring loads across the fracture using a load cell. Correlation data were statistically compared with a Fisher transformation and z test (p < 0.05). Residual compression was statistically greater for wire compared with suture. There was no difference in fracture displacement between groups during low loads. Suture had significantly greater displacement compared with wire at high loads. Failure loads were significantly greater for wire at both load settings. Wires transmitted forces across the joint surface more readily than sutures. Suture tension bands had lower ultimate failure loads and less compression at the fracture site. However, if low loads are expected or if the fracture is reduced easily, the suture tension band may be an appropriate alternative to wire fixation. Perhaps, in small children or when using casts in bigger children, a bioabsorbable suture may be used for fracture stabilization avoiding the need for extensive surgery to remove the fixation material.

Olecranon Fractures Repaired With FiberWire or Metal Wire Tension Banding: A Biomechanical Comparison

Tension band constructs are commonly used for olecranon fracture fixation. The purpose of this study was to determine if a tension band constructed of FiberWire (Arthrex, Naples, FL), a high-strength polyester and polyethylene suture, will provide fixation that is equivalent to an 18-gauge metal wire tension band. The following 4 fixation methods were biomechanically tested in cadaveric elbows with a simulated transverse olecranon fracture: (1) Kirschner wires (K-wires) with an 18-gauge metal wire tension band, (2) K-wires with a FiberWire tension band, (3) intramedullary screw with an 18-gauge metal wire tension band, and (4) intramedullary screw with a FiberWire tension band. Each elbow underwent all 4 repair methods. The K-wire repairs were performed first followed by the intramedullary screw repairs. The order of the tension band (FiberWire or metal wire) was randomly assigned. Specimens were tested under cyclic loading conditions that simulated stresses generated by (1) active range of motion and (2) pushing up from a chair. Fracture displacement was recorded by using transducers placed at the articular surface of the fracture and on the posterior surface of the olecranon. There were no significant differences in fracture displacement associated with the use of a high-strength suture or metal wire tension band under conditions simulating active range of motion or a more vigorous physiologic stress. Also, there were no significant differences associated with the use of an intramedullary screw versus K-wire fixation under either condition. The biomechanical characteristics of high-strength suture tension bands are equivalent to 18-gauge metal wire tension bands when used with either an intramedullary screw or K-wires. The fatigue patterns of high-strength suture tension bands and metal wire tension bands are similar. There is not a significant difference between the biomechanical strength of intramedullary screw fixation constructs and K-wire constructs. FiberWire tension bands may be used in place of metal wire tension bands without sacrificing fixation strength.

Use of modified tension band sutures for fingernail disruptions

A series of 66 patients, aged between 1 and 70 years, with 70 disruptive injuries to finger nails was reviewed. The injuries were treated by cleaning of the finger, evacuation of haematoma and anatomical replacement of the nail plate, or a substitute, which was secured with a modified dorsal tension band suture without formal repair of the nail bed. K-wire fixation of the distal phalanx was employed only in the event of displaced fracture of the distal phalanx, complete absence of the nail plate and laceration extending to the distal pulp. This simple method, which bypasses the injured and friable, but vital nail structures resulted in uncomplicated re-formation of the normal nail plate in all of the cases. Removal of the nail plate and formal repair of the nail bed is not necessary in any age group with finger nail disruptions.

Open Intramedullary Nail with Tension Band Sutures &amp; Lock Sutures on Proximal Humeral Three-part Fracture

Open Intramedullary Nail with Tension Band Sutures &amp; Lock Sutures on Proximal Humeral Three-part Fracture

A new and effective tension-band braided polyester suture technique for transverse patellar fracture fixation

Concerning the tension-band principle of internal fixation, this study aims to establish whether any difference in interfragmentary gap exists after bone-reducing forceps are released, when a recommended suture-knot technique and a new technique are tested in vitro on a purpose built machine that features a model of a transverse fracture of the patella. In addition, a standard tension-band wiring technique has also been tested as one form of control. Satisfactory compression at a fracture site reduces the risk of failure of fixation, loss of reduction (interfragmentary gap >2mm) and subsequent risks of malunion, delayed union, and ultimately non-union from excessive movement. Stainless-steel wire can provide a stable rigid construct but is associated with complications. Tension-band fixation employing a braided polyester non-absorbable suture provides a less rigid construct. However, satisfactory clinical results and fewer complications are reported. The method by which a suture is tied has an effect on initial compression provided the fracture is reduced. However, it also has an effect on the degree of fracture gap once it is subject to biomechanical distraction. By measuring the output of a strain gauge Wheatstone bridge of a purpose built rig that had been calibrated against fracture gap and compression force, the various tension-band fixation techniques as discussed above were evaluated. The tension-band suture technique examined in this work (the modified Wagoner's Hitch) has been evaluated. It has quantitatively shown less fracture gap than other recognised tension-band suture and wire techniques. The results exhibit statistical significance (p<0.001). This evaluation study has produced quantitative and comparable data of fracture gap as observed with the model of a transverse patella fracture, for both new and established surgical techniques. The contribution this study has made to the knowledge of the subject is that a testing device similar to the one in this study may be useful in the future for conducting preliminary studies of new or established tension-band techniques. The proposed tension-band suture method tested in this dissertation provided statistically significant quantitative data, which may after further work, support its use as an alternative method in the clinical setting.

Tension band suturing for the treatment of displaced type 2 lateral end clavicle fractures

Non-operative treatment of Neer type 2 lateral end clavicle fractures presents a difficult problem due to the high incidence of non-union, delayed union and resulting shoulder girdle instability. Operative techniques described may require extensive soft tissue reconstruction, implant removal or lead to implant failure. We report a modified tension band suturing technique for the treatment of these lateral end displaced clavicle fractures that avoids these problems of extensive soft tissue dissection, implant removal or implant failure. Ten patients were reviewed clinically, radiologically and with Constant assessment score outcomes using the tension band suture for the treatment of these fractures. All the fractures had healed at a mean follow-up of 9.2 weeks (range 6-16 weeks) with a mean Constant score of 91 and the power was comparable to the normal shoulder using the Nottingham Myometer. The results of this pilot study for treatment of Neer's type 2 lateral end clavicle fractures are very encouraging. We do recommend the need for a prospective larger study of this technique for the treatment of Neer type 2 lateral end clavicle fracture to evaluate this technique further.

Olecranon fracture fixation utilizing a bioabsorbable tension band construct: analysis of stability with motion in a cadaveric model

This study was performed to determine if tension band suturing with bioabsorbable materials can maintain fracture (osteotomy) reduction when subjected to an early motion protocol. Olecranon osteotomies were created in 13 cadaveric upper extremities and then sequentially fixed with axial Kirschner wires, and tension band wiring/suturing utilizing: musical #1 PDS (Ethicon Inc., Somerville, New Jersey, USA), musical #1 Panacryl (Ethicon Inc.), musical #2 Panacryl (Ethicon Inc.), and 18 gauge surgical wire. Specimens were cycled through a range of motion in a continuous passive motion machine. Specimens fixed with K-wires only, musical #1PDS and musical #1 Panacryl tension band suturing failed to maintain osteotomy reduction. Only surgical steel and musical #2 Panacryl maintained osteotomy reduction; both were superior to the other fixation methods (P<0.001). The musical #2 Panacryl suture is an excellent choice for a tension band suture construct; it retains 80% of its breaking strength at 3 months, is fully absorbed, and maintains osteotomy reduction throughout a passive motion protocol.

ARTHROSCOPIC REPAIR OF FULL-THICKNESS TEARS OF THE SUPRASPINATUS

Background: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. Methods: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. Patients ranged in age from twenty-nine to seventy-nine years. The average duration of follow-up was twenty-nine months. Fifty-one patients (fifty-one shoulders) had a computed tomographic arthrogram, and fourteen had a magnetic resonance imaging scan, performed between six months and three years after surgery. All patients were assessed with regard to function and the strength of the shoulder elevation. Results: The rotator cuff was completely healed and watertight in forty-six (71%) of the sixty-five patients and was partially healed in three. Although the supraspinatus tendon did not heal to the tuberosity in sixteen shoulders, the size of the persistent defect was smaller than the initial tear in fifteen. Sixty-two of the sixty-five patients were satisfied with the result. The Constant score improved from an average (and standard deviation) of 51.6 ± 10.6 points preoperatively to 83.8 ± 10.3 points at the time of the last follow-up evaluation (p < 0.001), and the average University of California at Los Angeles score improved from 11.5 ± 1.1 to 32.3 ± 1.3 (p < 0.001). The average strength of the shoulder elevation was significantly better (p = 0.001) when the tendon had healed (7.3 ± 2.9 kg) than when it had not (4.7 ± 1.9 kg). Factors that were negatively associated with tendon healing were increasing age and associated delamination of the subscapularis or infraspinatus tendon. Only ten (43%) of twenty-three patients over the age of sixty-five years had completely healed tendons (p < 0.001). Conclusions: Arthroscopic repair of an isolated supraspinatus detachment commonly leads to complete tendon healing. The absence of healing of the repaired rotator cuff is associated with inferior strength. Patients over the age of sixty-five years (p = 0.001) and patients with associated delamination of the subscapularis and/or the infraspinatus (p = 0.02) have significantly lower rates of healing. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Arthroscopic Repair of Full-Thickness Tears of the Supraspinatus: Does the Tendon Really Heal?

Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. Patients ranged in age from twenty-nine to seventy-nine years. The average duration of follow-up was twenty-nine months. Fifty-one patients (fifty-one shoulders) had a computed tomographic arthrogram, and fourteen had a magnetic resonance imaging scan, performed between six months and three years after surgery. All patients were assessed with regard to function and the strength of the shoulder elevation. The rotator cuff was completely healed and watertight in forty-six (71%) of the sixty-five patients and was partially healed in three. Although the supraspinatus tendon did not heal to the tuberosity in sixteen shoulders, the size of the persistent defect was smaller than the initial tear in fifteen. Sixty-two of the sixty-five patients were satisfied with the result. The Constant score improved from an average (and standard deviation) of 51.6 +/- 10.6 points preoperatively to 83.8 +/- 10.3 points at the time of the last follow-up evaluation (p < 0.001), and the average University of California at Los Angeles score improved from 11.5 +/- 1.1 to 32.3 +/- 1.3 (p < 0.001). The average strength of the shoulder elevation was significantly better (p = 0.001) when the tendon had healed (7.3 +/- 2.9 kg) than when it had not (4.7 +/- 1.9 kg). Factors that were negatively associated with tendon healing were increasing age and associated delamination of the subscapularis or infraspinatus tendon. Only ten (43%) of twenty-three patients over the age of sixty-five years had completely healed tendons (p < 0.001). Arthroscopic repair of an isolated supraspinatus detachment commonly leads to complete tendon healing. The absence of healing of the repaired rotator cuff is associated with inferior strength. Patients over the age of sixty-five years (p = 0.001) and patients with associated delamination of the subscapularis and/or the infraspinatus (p = 0.02) have significantly lower rates of healing.

Surgical treatment of fractures of the distal clavicle with polydioxanone suture tension band wiring: an alternative osteosynthesis

AbstractFracture of the distal clavicle type II (Neer) is an indication for surgical intervention. We report our experience in 12 patients with acute clavicular fractures and operative treatment with polydioxanone suture (PDS) tension band wiring. The patients were assessed 6 and 12 weeks postoperatively by radiological and clinical evaluation and with the Constant Murley score. All 12 patients had an excellent functional result 12 weeks postoperatively. The Constant Murley score was excellent in all patients. The PDS band can be considered as an alternative osteosynthesis. In the context of the current literature, the advantages and disadvantages of this new procedure are discussed.

Tension Band Fixation for Unstable Two-Part Humeral Fractures in Patients with Osteopenic Bone (Parachute Technique)

Tension Band Fixation for Unstable Two-Part Humeral Fractures in Patients with Osteopenic Bone (Parachute Technique)

Management of nail-bed fracture-lacerations using a tension-band suture

Nail-bed lacerations are frequently encountered in the emergency room and, along with other fingertip injuries, constitute the most common type of hand injury. 1 Among the various mechanisms of injury, trapping the finger in a closing door is the most common, 2 accounting for 25% of these injuries. 3,4 The rigid nail plate itself remains intact but gets separated from the underlying proximal nail bed to a variable extent and may come to lie on the dorsum of the proximal nail fold. In approximately 50% of cases, the underlying distal phalanx is fractured, 5 resulting in a transverse laceration of the nail bed, which is displaced with the osseous fragments. In extreme instances, the fingertip is partially amputated, remaining attached by only a narrow bridge of palmar soft tissues. Adequate primary treatment is necessary to minimize subsequent nail deformity. 6 The recommended management of these injuries is reduction of the fracture followed by repair of the nail bed. The nail plate is replaced and the fracture is stabilized with Kirschner wires (K-wires). 7,8 I describe here a technique for obtaining stability of the fracture in such injuries without the use of K-wire fixation, using a dorsal tension-band suture.

Biomechanical analysis of mallet finger fracture fixation techniques

A biomechanical study was conducted to determine the best fixation technique for mallet finger fracture among four commonly used methods. Considerations were technical complications, biomechanical properties, and maintenance of reduction. Techniques tested included Kirschner wire, figure-of-eight wire, tension band wire, and tension band suture. Technical complications were frequent with both the Kirschner wire and tension band wire techniques. Biomechanical testing yielded significantly greater energy absorbed to failure and a trend toward greater peak loads to failure for both the figure-of-eight wire and tension band suture techniques. Irreversible loss of reduction during testing occurred in all of the Kirschner wire-fixed fractures, in 60% of the tension band wire-fixed fractures, and in 50% of the figure-of-eight wire-fixed fractures. No irreversible failure occurred in the tension band suture group.