Tension Band Technique Research Articles

Repair of olecranon fractures using fiberWire without metallic implants: report of two cases

Olecranon fractures are a common injury in fractures. The tension band technique for olecranon fractures yields good clinical outcomes; however, it is associated with significant complications. In many patients, implants irritate overlying soft tissues and cause pain. This is mostly due to protrusion of the proximal ends of the K-wires or by the twisted knots of the metal wire tension band. Below we described 2 cases of olecranon fractures treated with a unique technique using FiberWire without any metallic implants. Technically, the fragment was reduced, and two K-wires were inserted from the dorsal cortex of the distal segment to the tip of the olecranon. K-wire was exchanged for a suture retriever, and 2 strands of FiberWire were retrieved twice. Each of the two FiberWires was manually tensioned and knotted on the posterior surface of the olecranon. Bony unions could be achieved, and patients had no complaint of pain and skin irritation. There was only a small loss of flexion and extension in comparison with that of the contralateral side, and the patient did not feel inconvenienced in his daily life. Using the method described, difficulty due to K-wire or other metallic implants was avoided.

압박 긴장대 방법을 이용한 구상 돌기 골절의 견고한 고정과 조기 운동을 통한 주관절 기능의 향상

Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O`Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was (range: ), the mean flexion was (range: ), the mean pronation was (range: ) and the mean supination was (range: ). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.

Stress Fracture of the Fifth Metatarsal Base Caused by Tension Band Wiring

Tension band technique has been described as a successful method of treatment for the fractures of the proximal part of the fifth metatarsal bone. A high rate of union and a low rate of complications have made this mode of treatment popular, especially in patients with nonunion and high-level athletes with stress fracture of the proximal fifth metatarsal bone. The authors report a case of an avulsion fracture of the base of the fifth metatarsal bone treated with tension band wiring fixation, which resulted in a stress fracture 1 year after the tension band wiring. The authors recommend a K-wire perforation and tension band drill hole distal to the watershed area of the fifth metatarsal bone and removal of metalwork 6 to 12 months after fracture union to avoid this complication.

Monteggia fractures in adults:Review of 48 cases

Objective To review the surgical treatment outcomes of Monteggia fractures in adults. Methods From September 1994 to January 2007, 48 patients with Monteggia fracture were treated in our hospital. The average age was 36.4 years ( 18 -66 years). According to the classification of Bado, there were 22 cases of type Ⅰ, 17 cases of type Ⅱ, 6 cases of type. Ⅲ and 3 cases of type Ⅳ fractures. In 54.2% of the patients, the lesions were associated with multiple traumas. Eight cases had radial/median/ulnar nerve injuries. In 44 cases, treatment consisted of open reduction or osteotomy and internal fixation of the ulnar fracture using different methods of ostcosynthesis (3.5 mm DCP, 3.5 mm reconstruction plates, tension band technique with Kirschner wires, and one-third tubular plates). Initial treatment of the radial head dislocation was attempted by closed reduction under fluoroscopy monitoring. Subsequent open reduction was performed in 37 cases after failed close reduction. Four of these cases underwent annular ligament repair or reconstruction. Four had partial or complete resection of the radial head. There were seven open fractures with one case developing chronic infection. Results The average foLlow-up was 17 months (6 -26 months). At the most recent follow-up examination, the average score, according to the system of Broberg and Money, was 84.2 points (range, 31 to 100 points). The result was excellent for 17 patients, good for 15, fair for 9, and poor for 7. Nine of the 16 patients who had an unsatisfactory (fair or poor) result had had a Bado type-Ⅱ fracture with a concomitant fracture of the radial head. Recovery of hand function was observed in 8 cases that had concomitant nerve injury and 6 cases that suffered nerve injury due to close reduction. Conclusion Monteggia fractures in adults are fraught with compheations despite good functional results in the majority of cases. The patient should be informed early on of the risks of residual functional deficits and the need for further surgical intervention.

Anatomical and biomechanical evaluation of the tension band technique in patellar fractures

Tension band wiring for patellar fractures is common, but some recent reports refer to disadvantages of this approach. Our anatomical and biomechanical study focused on use of tension band techniques in patellar fractures. The anatomy of the patella and tendon insertion was examined with knee magnetic resonance imaging (MRI) and correlated with the technical requirements of the tension band. Tension band wiring over tendinous tissue was simulated and calculated with a cyclic biomechanical test on cow patellae. According to tension band templating on the MRI section, Kirschner wire insertion was needed for the tension band to turn over the tendinous tissue. The tension band became more stable while turning over less tendinous tissue and more adjacent bone surface. Nevertheless, cyclic loading tests indicate that all tension band applications in this study lose their initial stability. Excessive initial compression by the tension band resulted in bending of the Kirschner wire and thus reduction failure. For optimum stabilisation, tension force transfer should be done directly on bone or at least material that protects the tendon would be useful.

Comparison of Two Tension-band Fixation Materials and Techniques in Transverse Patella Fractures:A Biomechanical Study

This study compared the biomechanical properties of 2 tension-band techniques with stainless steel wire and ultra high molecular weight polyethylene (UHMWPE) cable in a patella fracture model. Transverse patella fractures were simulated in 8 cadaver knees and fixated with figure-of-8 and parallel wire configurations in combination with Kirschner wires. Identical configurations were tested with UHMWPE cable. Specimens were mounted to a testing apparatus and the quadriceps was used to extend the knees from 90 degrees to 0 degrees; 4 knees were tested under monotonic loading, and 4 knees were tested under cyclic loading. Under monotonic loading, average fracture gap was 0.50 and 0.57 mm for steel wire and UHMWPE cable, respectively, in the figure-of-8 construct compared with 0.16 and 0.04 mm, respectively, in the parallel wire construct. Under cyclic loading, average fracture gap was 1.45 and 1.66 mm for steel wire and UHMWPE cable, respectively, in the figure-of-8 construct compared with 0.45 and 0.60 mm, respectively, in the parallel wire construct. A statistically significant effect of technique was found, with the parallel wire construct performing better than the figure-of-8 construct in both loading models. There was no effect of material or interaction. In this biomechanical model, parallel wires performed better than the figure-of-8 configuration in both loading regimens, and UHMWPE cable performed similarly to 18-gauge steel wire.

Rupture of the intra-articular portion of the long head of the biceps associated with a symptomatic os acromiale

We report the case of a 45-year-old male who presented with a 5-year history of shoulder pain following an injury. Clinical and radiological investigations revealed a ruptured long head of the biceps and a meso-os acromiale. We performed an arthroscopic resection of the intra-articular stump of the long head of the biceps, followed by internal fixation of the mobile os acromiale using a tension band technique. Rupture of the long head of the biceps associated with a symptomatic os acromiale has not been previously described. This case reinforces the importance of routine shoulder arthroscopy in the treatment of symptomatic os acromiale.

Proximal Interphalangeal Joint Arthrodesis Using the Tension Band Technique

Arthritis and instability of the proximal interphalangeal (PIP) joints of the hand leads to chronic pain and decreased hand function. Proximal interphalangeal joint arthrodesis is an effective means of restoring hand function. The tension band technique is a reliable and cost-effective means of stabilizing the arthrodesis while allowing early hand motion. The dorsal tension band causes compression at the arthrodesis site during active motion, further facilitating healing. The technique is cost effective, using inexpensive pins and a wire. Complications include delayed union, pin protrusion from the bone, and painful hardware.

Tension band stabilisation of acetabular physeal fractures in four kittens.

The surgical repair of acetabular physeal fractures in four kittens using a screw and tension band technique is reported. This was an appropriate method for restoring articular congruency and improving pelvic alignment. All cases had an excellent outcome and full limb use following fracture repair. In kittens younger than 12 weeks, there is a possibility of premature fusion of the acetabular bone resulting in development of a deformed, shallow acetabulum and hip subluxation. However, surgery is still justified when there is pelvic canal narrowing to decrease the risk of future defecatory problems. Early implant removal in such young kittens may decrease the severity of deformity caused by premature physeal closure. In kittens of 16 weeks or older, the prognosis is good for normal acetabular development and implant removal is not necessary.

Arthroscopic Grafting of Greater Tuberosity Cyst and Rotator Cuff Repair

Cysts of the greater tuberosity can be a normal finding independent of age and concurrent rotator cuff tear. The presence of a large greater tuberosity cyst can present a challenge at the time of rotator cuff repair. We present a 1-step arthroscopic technique to address these defects at the time of rotator cuff repair using a synthetic graft (OsteoBiologics, San Antonio, TX) originally designed to address osteoarticular defects. With the viewing portal established laterally, a portal allowing perpendicular access to the cyst is established. The cyst is thoroughly debrided, and a drill sleeve is then introduced perpendicular to the surrounding bone, serving as a guide for the matching drill to create a circular socket. A correspondingly sized TruFit BGS cylindrical implant (OsteoBiologics) is then implanted by use of the included instrumentation. The scaffold is placed flush with the surrounding bone. Because our arthroscopic rotator cuff protocol uses a tension-band technique with placement of suture anchors distal and lateral to the rotator cuff footprint, we are subsequently able to proceed with routine rotator cuff repair.

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.

Screw and tension band fixation for triple arthrodesis: A technique report

Stabilisation of the talonavicular joint in arthrodesis can be difficult, particularly in osteopoenic bone, and this may lead to non-union. A tension band technique for stabilisation is described. This has been used as part of the fixation in 44 triple arthrodeses. One hundred percent union rate has been achieved with few complications.

Application of Circular External Fixator under Arthroscopic Control in Comminuted Patella Fractures: Technique and Early Results

Comminuted fractures of the patella are traditionally treated by internal fixation. The modified tension-band technique is widely accepted for internal fixation. The management of comminuted fractures often requires additional K-wire and/or circlage material and wide surgical exposure. Therefore, symptoms and complications related to the stainless steel wire are not uncommon in these cases. We present a new alternative treatment technique for comminuted patellar fractures. Five comminuted patellar fractures of four patients were treated by circular external fixator (CEF) under arthroscopic control. The mean patient age was 32.5 (range 24-41) years and mean follow-up was 22 (range 20-28) months. In four cases, union was completed by the sixth week; in the other case, union was completed by the eighth week. The frames were removed after union of the fracture was documented. When the CEF was removed, full knee range of motion was observed full in all patients, and the patients returned to their normal activities of living in a few days. The mean Lysholm score was 94 (range 85-100) after treatment. CEF application under arthroscopic control can help avoid some complications of the traditional treatment methods, particularly in comminuted fractures of the patella. The most important advantage of this technique is to allow active knee motion in the early postoperative period so patients can return to activity of daily living soon after the implant removal. In addition, arthroscopic examination of the knee joint provides an assessment of any other intra-articular lesions. This technique allows healing of the fracture with low morbidity.

Comparison of three fixation methods in transverse fractures of the patella in a calf model

We evaluated the strength of three different fixation methods against distraction forces in a transverse fracture model of calf patellae. Thirty calf patellae were randomly divided into three groups equal in number. Transverse fractures were induced at the same localization in all the samples. The fractures were fixed with a modified anterior tension band technique, Acutrak 4/5 screws, and a combination of Acutrak 4/5 screws and tension band technique in three groups, respectively. Following fixation, each patella was mounted in a compression-distraction testing machine from the quadriceps and patellar tendons on each side of the patella, and equal distraction forces were applied to each patella. The average load to failure at the fracture site was calculated and the results were compared with the Friedman test. The mean failure loads were significantly different in three groups, being 288.8+/-40.1 newton (N), 878.5+/-68.6 N, and 938.6+/-38.8 N, respectively (p<0.001). The most efficient stabilization was obtained in the third group in which Acutrak 4/5 screws and the tension band application were used in combination, while the modified anterior tension band technique alone was found to be the weakest fixation technique. Our results showed that Acutrak 4/5 screws enabled a rigid fixation in the surgical treatment of patellar fractures.

New Tension Band Material for Fixation of Transverse Olecranon Fractures: A Biomechanical Study

This study tested the use of braided polyethylene cable as an option for repairing transverse olecranon fractures. Six cadaveric elbows underwent a transverse olecranon osteotomy followed by fixation with tension band constructs using 18-gauge wire and Secure-Strand (U.S. Surgical, North Haven, Conn). Distraction forces up to 450 N were applied to the triceps tendon while measuring fracture displacement with an extensometer. The average maximal fracture gap with the standard AO tension band technique using stainless steel wire was 0.66 +/- 0.43 mm, as opposed to 0.68 +/- 0.45 mm with braided polyethylene cable. A paired t test indicated no significant difference between the two materials. These results support the feasibility of braided polyethylene cable as an alternative to the standard steel-wire tension band.

Modified Tension Band Technique With Looped Pin

Modified Tension Band Technique With Looped Pin

Tension band stabilization of fractures and luxations of the thoracolumbar vertebrae in dogs and cats: 38 cases (1993-2002).

To determine the outcome of dogs and cats in which a tension band technique was used to stabilize traumatic fractures and luxations of the thoracolumbar vertebrae. Retrospective study. 38 client-owned animals (22 dogs and 16 cats) weighing between 1.4 and 45 kg (3 and 99 lb). Medical records of cats and dogs that underwent tension band stabilization of thoracolumbar fractures and luxations at the University of Zurich between 1993 and 2002 were reviewed. The stabilization technique was a modification of a spinal stapling technique with a figure 8 hemicerclage wire placed in a tension band fashion across the lesion. Neurologic status, lesion location and type, and concomitant traumatic injuries were assessed from the medical records and preoperative radiographs. Clinical outcome and complications were determined through follow-up examinations or telephone conversations with the owners. Complete or satisfactory neurologic recovery was achieved in 30 (79%) patients. Seven patients were euthanatized (6 owing to poor neurologic recovery and 1 owing to implant failure), and 1 dog was managed at home despite paraplegia. Clinically, only 4 patients (11%) had evidence of implant or fixation failure; all were dogs weighing > 16 kg (35 lb). Results suggest that the tension band technique may be appropriate for stabilization of fractures and luxations of the thoracolumbar vertebrae in cats and small- or medium-sized dogs. In larger dogs, fixation strength may be insufficient to stabilize certain fracture types and ancillary external or internal fixation methods may be needed.

Olekranon Kırıklarında Cerrahi Tedavi Sonuçlarımız

1992-2003 yillari arasinda cerrahi tedavi uyguladigimiz 29 deplase olekranon kirikli hasta retrospektif olarak degerlendirildi. 21 hasta erkek, 8 hasta kadindi. Ortalama yas 35 (12-61) idi. Kirik tipleri; 16 transvers, 7 parcali, 3 transvers impakte, 3 oblik kirik idi. Cerrahi tedavi olarak 21 hastaya Arbeitsgemeinschaft fur osteosynthesefragen (AO) gergi bandi teknigi ile tespit, 7 hastaya vida ile tespit ve cok parcali kirigi olan bir hastaya eksizyon yapildi. Ortalama takip suremiz 4,5 yil (1-11 yil) idi. Olgularin agri, islev, hareket siniri ve rontgen bulgulari yonunden yapilan degerlendirilmesine gore (Murphy'nin puanlamasi) % 86 cok iyi ve iyi sonuclar alindi. Komplikasyon olarak yalnizca bir hastada Kirschner gocu goruldu. Iyi netice alinamayan hastalarda neticeye etki eden ek travmalar vardi. AO gergi bandi tekniginin olekranon kiriklarinda en cok uygulanan ve en iyi tespit oldugu sonucuna varildi The Results of Surgical Treatment of Fractures of the Olecranon Between 1992 and 2003, 29 patients with displaced olecranon fractures who were treated surgically were evaluated retrospectively. Twenty-one patients were male, eight patients were female. The mean age was 35 (range, 12 to 61). There were 16 transverse, 7 comminuted, 3 tranverse-impacted and 3 oblique type of fractures. Twenty-one patients with olecranon fractures were fixated with AO tension band technique, 7 patients were fixated with screw and in one patient with comminuted fracture excision was performed.The average follow-up period was 4,5 years (range, 1 to 11 years). The patients were evaluated according to Murphy criterias which inluded pain, function, range of motion and radiographic appearence, and in 25 (86%) patients excellent and good results were obtained. Kirschner wire migration was seen in only one patient as a complication. In patients with poor therapeutic outcome, there were additional traumas affecting the result. In olecranon fractures AO tension band tecnique is the most used technique, an affective treatment method

Nonunions of the Surgical Neck of the Humerus Treated With a Two-Tension Band Technique

Summary The combination of poor bone stock and excavation of the humeral head in surgical neck nonunions forms a surgical challenge often not amenable to standard screw and plate fixation. Key elements in the operative fixation are limited exposure, debridement, and impaction followed by minimal hardware relying on the soft tissue attachments of the rotator cuff. We have successfully used a 2 tension-band technique for these difficult problems that combines stable fixation with preservation of vascularity.

Anterior Sternoclavicular Dislocation Caused by Indirect Compression Trauma

Anterior dislocation of the sternoclavicular joint is extremely rare because the ligamentous connections surrounding the joint are strong. Since there is a very low complication rate, conservative treatment can be justified in most cases. Nonetheless, lack of reduction or, in case of re-dislocation, conservative treatment, is often associated with cosmetic asymmetry of the sternoclavicular joints due to ventral protrusion of the medial end of the clavicle. Furthermore, chronic pain, periarticular calcifications with ankylosis and progressive deformity may result. In cases of unsuccessful closed reduction and/or repeated re-dislocations despite corrective bandages, open reduction and fixation is indicated. An optimal, standardized operative procedure has not yet been established because of the small number of cases. The applied procedures include wire osteosynthesis, plate osteosynthesis, pin fixation with resorbable materials, complex capsular ligament reconstructions with displacement of tendons, resection of the medial end of the clavicle and arthrodesis of the sternoclavicular joint. We report about a patient who sustained an anterior dislocation of the sternoclavicular joint as a result of a road traffic accident. Initially, conservative treatment was implemented with closed reduction and a correction bandage. After repeated re-dislocation, despite the bandage, we decided to stabilize the reduction surgically using PDS cord for fixation in a transosseous tension band technique which aligned the anteriorly dislocated medial end of the clavicle with the sternal articulating surface. 1 year after operation, the patient is symptom-free. She is very satisfied with the cosmetic result. No further dislocation has occurred.