Tension Band Wire Fixation Research Articles

Cost Assessment of Plating Versus Tension Band Wiring Constructs for Treating Mayo Type 2A Olecranon Fractures

Tension band wiring (TBW) or plating may be used for fixation with similar clinical outcomes for adults with displaced Mayo 2A olecranon fractures. The primary hypothesis is that total direct costs (TDCs) for surgery are lower for TBW than plating. Our secondary hypothesis is that combined surgical TDCs are lower for TBW even with a 100% rate of subsequent tension band hardware removal and a 0% rate of plate removal. Patients who underwent TBW or plating of an isolated unilateral Mayo 2A olecranon fracture between July 2011 and January 2020 at a single academic medical center were identified. Then, TDC for each surgery on plate fixation, TBW, and hardware removal was obtained and converted to 2020 US dollars using information technology cost tools provided by our institution. Finally, relative TDCs were compared between plate fixation and TBW groups using univariate and multivariable generalized estimating equations with log-link. Of the 97 included patients, the mean age was 50 ± 21 years, and 48% were female. Tension band wiring and plate fixation were performed on 18% (17/97) and 82% (80/97) of male and female patients, respectively. Demographics were similar between groups, although the finding that plate fixation cost 2.6 times that of TBW within the index surgery was significant in the multivariable model, independent of potential confounders (coefficient 2.55, 95% confidence interval: 2.09-3.10). Additionally, mean TDC remained significantly greater for plate fixation even under the hypothetical situation where 100% TBW were removed, and the plate removal rate was 0% (cost difference 181%). Using TBW relative to plate fixation may improve the cost of care for operative Mayo 2A olecranon fractures. Furthermore, this finding was robust to the rate of hardware removal. Economic and Decision Analyses III.

Is It Essential to Apply Tension Band Wire Fixation in Non-Comminuted Displaced Transverse Fractures of the Olecranon (Mayo Type 2A)?

Is It Essential to Apply Tension Band Wire Fixation in Non-Comminuted Displaced Transverse Fractures of the Olecranon (Mayo Type 2A)?

Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures.

Olecranon fractures are common and usually treated operatively either by tension band wiring (TBW) or plate fixation (PF). The aim of this study was to assess early complications and reoperations and their predictive factors related to those operative methods. A retrospective analysis of all patients with an operatively treated olecranon fracture between 2007 and 2017 at Turku University hospital was performed. Reoperations, postoperative complications, and potential risk factors for these were recorded. A total of 434 patients (387 TBW and 47 PF) were identified. There was no statistically significant difference in the rate of early complications (49% vs. 62%, P = .262) or reoperations (38% vs. 53%, P = .079) between patients treated with TBW and PF. In the TBW group, the intramedullary placement of Kirschner (K)-wires predisposed patients to complications compared to transcortical placement of the K-wires according to multivariate analysis (odds ratio [OR] 1.94, P = .026). Younger age was associated with the frequency of reoperations, the odds decreasing 24% for every 10 years of age (P < .001). Further, patients with high-energy trauma mechanisms were reoperated more often compared to patients with low-energy trauma (OR 2.99, P = .002). Also, excellent postoperative reduction was associated with higher reoperation rate than good or fair reduction (OR 0.48, P = .033). There is a high risk of early complications and reoperations associated to both TBW and PF. Transcortical positioning of K-wires may reduce the rate of complications in TBW.

Correction of medial compartmental osteoarthritis knee joint by high tibial closed wedge osteotomy with tension band wiring and cortical screw fixation in a rural set up

Introduction: Osteoarthritis of the Knee is a Chronic debilitating disease excessive pressure leads to breakdown of the cartilage matrix, architectural changes in the subchondral bone, further altering the joint geometry. Aims and Objective: The effect of TBW with 2 cortical screws in cases of uni-compartmental O.A. Knee joint 32 cases were studied. Result: Lateral wedge osteotomy done 1.5 cm distal to joint margin to avoid fracture of tibial plateau intraoperatively. Height of wedge is taken dependent on varus angle calculated from x-rays, for each degree 1 mm height of wedge is taken. 2 cortical screws fixed distal to osteotomy site. Conclusion: It is a cost effective technique with use of minimum hardware and early post operative mobilization in patients who cannot afford Knee Arthroplasty in a rural set up.

Determination of Functional Outcomes of Displaced Olecranon Fracture Fixed with Intermedullary Partially Threaded Screw Augmented with Tension Band Wiring

Introduction: Orthopaedic injuries involving the olecranon are among the most often encountered in the emergency department. Objective: To determine the functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring Material and methods: This Descriptive/multicentric case series was conducted in Department of Orthopedics, Bahawal Victoria Hospital/Civil (Sadiq Abbasi) Hospital, Bahawalpur during June 2019 to June 2021. Patients who came through the emergency department and met the inclusion criteria were enrolled and given informed permission after clearance from the hospital's ethics committee. During general anesthesia or a biere’s block, all patients received tension band wire and intramedullary screw fixation. Results: Functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring was recorded as excellent in 57.39%(n=66), 32.17%(n=37) had good outcome, 10.44%(n=12) had fair outcome. Conclusion: We concluded that that functional outcomes of displaced olecranon fracture fixed with intermedullary partially threaded screw augmented with tension band wiring is good; however, validation is required through other local studies. Key words: Olecranon fracture, Intramedullary partially threaded screw, Tension band wiring, and Campbell’s posterolateral approach

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for step-cut olecranon osteotomy

Olecranon osteotomies are frequently used to expose distal humeral intraarticular fractures. The step-cut olecranon osteotomy (SCOOT) is an augmented version of the oblique olecranon osteotomy, which has recently been evaluated biomechanically with tension band wiring (TBW) fixation. However, complications with TBW are common. In this study, we, therefore, compared the mean load to failure of TBW with compression screws for SCOOT fixation. We hypothesized a higher load to failure for the compression screw group. We performed a SCOOT on 36 Sawbones. Eighteen were fixed with TBW, and another 18 with two compression screws. The humeroulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna, while the humeroulnar joint is in a fixed position. Eight models of each fixation group were tested at 20°, and eight at 70° of flexion by isometrical loading until failure, which was defined as either a complete fracture or gap formation of more than 2 mm at the osteotomy site. At 20° of flexion, mean load to failure was similar between the TBW group (1360 ± 238 N) and the compression screw group (1401 ± 261 N) (P= .88). Also, at 70° of flexion, the mean load to failure wassimilar between the TBW group (1398 ± 215 N) and the compression screw group (1614 ± 427 N) (P= .28). SCOOTs fixed with TBW and compression screws showed similar loads to failure. A SCOOT fixed with compression screws might be a valuable alternative for surgeons when treating intraarticular distal humeral fractures. However, future invivo studies are necessary to confirm our results in a clinical setting.

More metalwork removals in patients with olecranon fracture treated by tension band wiring than plate fixation-a propensity score matching analysis

BackgroundTraditional tension band wiring and plate fixation represent the commonest methods for treating olecranon fractures. However, there is no agreement on which method provides the best outcome. The aim of this retrospective study is to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture.MethodA total of 107 patients aged between 18 and 85 had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n = 49) or PF (n = 58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation.ResultsFunctional effects between two groups are similar (in terms of Mayo Elbow Performance Score (MEPS), the patients’ range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, similar primary treatment efficacy (indicated by MEPS> 90) in 2 groups and more primary adverse events (indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient = − 1.24 < 0, P = 0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group.ConclusionWhen initially discussing the surgical approach with patients, physicians should fully weigh the possibility that TBW may lead to a second surgery due to the higher risk of internal fixation removal and that TBW won’t yield better functional outcomes than PF .

"Fishing net" suture augmenting tension-band wiring fixation in the treatment of inferior pole fracture of the patella.

Inferior pole fracture of the patella (IPFP) is difficult to repair and stabilize clinically. Although various fixation techniques have been developed, fixation strength and mobility remain daunting challenges to orthopedic surgeons. The goal of this research is to evaluate the biomechanical strength and clinical outcomes of a novel "fishing net" suture fixation procedure. Four finite element models, modified tension-band wiring fixation, anchor suture fixation, basket plate fixation and "fishing net" suture fixation were built to compare the fixing efficacy of "fishing net" suture fixation with three other fixation methods during IPFP fixation. From January 2018 to February 2019, 17 patients who suffered IPFP and treated by "fishing net" suture (FNS) fixation were compared with 20 patients treated by tension-band wiring (TBW) fixation in database and the two groups were evaluated postoperatively using the modified Cincinnati knee rating system. Biomechanical evaluation showed that the relative displacement values of proximal patella measured by three pairs of points on both sides of the fracture line were the lowest using the "fishing net" suture fixation, while fixation using tension-band wiring and basket plate showed similar levels of stability that were less desirable than the "fishing net" method. As to clinical outcomes, there were 17 (100%) patients exhibited excellent or good results with no internal fixation failures in the FNS group compared to three internal fixation failures in the TBW group. The biomechanical and clinical results suggest that the "fishing net" suture fixation is a viable candidate for fixation of IPFP.

Treatment of Distal End Clavicle Fractures: Suture Fixation Versus Tension Band Wiring

Background: There are several methods like Kirschner wire, suture fixation, different plaque and etc. for surgical treatment of Neer’s type-II fractures of distal end of clavicle. Objectives: Due to lack of gold standard in treatment of fractures of distal end of clavicle, this study was conducted to compare therapeutic outcomes of tension band wire (TBW) and suture fixation (SF) in treatment of this type of fractures. Methods: This retrospective cross sectional-analytic study was performed on patient with confirmed unilateral unstable Neer’s type-II fracture of distal end of clavicle. Based on surgeon preferred protocol for fixation of fractures, for patients from 21 September 2010 to 20 March 2013 pin and wire were used (TBW group) and patients from 21 March 2013 to 23 September 2015, were enrolled as SF group. Demographic information were recorded separately for both groups. All patients were evaluated and scored based on constant score, VAS, symptomatic hardware, loss of reduction in 3 and 6 months and final visit after surgery. Results: Among 85 patients, 41 and 44 patients were allocated in TBW and SF groups respectively. Mean of follow-up time was 36.7 months. Our findings showed that both groups in three follow-up periods were similar with regard to shoulder function based on constant score, VAS score, loss of reduction, and nonunion. But SF group had lesser symptomatic hardware rather than TBW group (P=0.001). Conclusion: Although the results of pain intensity and function were similar in two groups, existence of symptomatic hardware and need of hardware removal in TBW method are weak points which should be considered.

Comparative study of tension band wiring and malleolar screw fixation for the treatment of medial malleolus fracture

Background: Malleolar fractures are the most common type of ankle fractures. These intra-articula fractures need to be managed properly as they have high chance of non-union and are usually treated operatively. Open reduction and internal fixation with malleolar screw or tension band wiring (TBW) are mostly used treatment modalities for medial malleolus fracture. The objective of this study was to compare the functional and radiological outcome of patient who underwent TBW or malleolar screw fixation. Methods: It was a prospective comparative study conducted in 40 patients at Gandaki Medical College over the period of 24 months. Patients fulfilling the inclusion criteria were included in in the study. 20 patients were randomly selected in either group of malleolar screw and TBW which were followed for six months postoperatively. Functional outcome was measured using Olerud and Molander scoring system. Radiological outcome, adverse radiological outcome, range of motion and complications were studied and compared. Results: The mean age of TBW group was 41.3± 14.76 while in malleolar screw group it was 39.65±15.34. Male to female ratio in TBW group and malleolar screw group was 0.82 and 0.66 respectively which is not statistically significant. Mode of injury, fracture type pre and postoperative hospital stay and duration of surgery were statistically similar in both the groups. Most common mode of injury was RTA (50%) and twisting of ankle (35%). Higher rate of smoking was seen in malleolar screw group(40%) than in TBW group(20%) while alcohol consumption was seen in 40% TBW patients and 15% malleolar screw patients. Average duration of bony union was significantly higher in TBW group (8.32±1.61 weeks) compared to malleolar screw fixation group (10.69±3.35weeks) (P=0.008), however there is no significant difference in term of functional outcome score, radiological outcome and complication rate. Conclusions: There is no significant difference in term of functional outcome and complication rate between TBW or malleolar screw fixation for medial malleolar fracture however, patients treated with TBW fixation tend to show earlier radiological union.

Comparative study of tension band wiring and pre contoured locking compression plate fixation in olecranon fractures in adults

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Olecranon fractures are about 10% of all proximal forearm fractures.Mostly intra articular fractures, require anatomical reduction and internal fixation for satisfactory clinical outcomes. The most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of olecranon fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a comparative study including 30 adult patients of olecranon fracture classified by Mayo classification and operated upon by tension band plating (group A) and tension band wiring (group B) at Department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All operated cases between the period of January 2018 to August 2019 with follow up of 1 year were assessed on the basis of functional outcome using Mayo elbow performance score&lt;strong&gt; &lt;/strong&gt;(MEPS).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The MEPS, 73% of the patients in group A achieved a good to excellent results in comparison to 60% in group B. no significant differences between the two groups could be detected regarding the clinical and radiographic outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in MEPS, improvement rate and ROM between TBW and PF for OFs. More high-quality studies are required to further confirm our results as most of the cases included in study belonged to Mayo type IIA category.&lt;/p&gt;

Comparison between headless compression screws and tension band wires for the fixation of medial malleolar fractures: a prospective randomized trial.

To date, there has been no prospective randomized trial supporting the rationale of the use of headless compression screw (HCS) compared to conventional fixation methods for medial malleolar fractures. This study aimed to prospectively compare the outcomes of the HCS and tension band wire (TBW) for the fixation of medial malleolar fractures. Sixty patients were randomized to receive either an HCS or a TBW for the fixation of a medial malleolar fracture. Clinical outcomes were assessed using the Olerud-Molander ankle score (OMAS), EuroQoL five-dimensional instrument (EQ-5D) score, visual analog scale (VAS) score, patient satisfaction with implant-related symptoms, operative time, and incision length. Radiographic outcomes were assessed using the presence of nonunion, delayed union, and articular incongruity. Clinical and radiographic assessments were performed at 2 and 6weeks and 3, 6, and 12months postoperatively. The OMAS, EQ-5D score, VAS score, and operative time did not differ between the HCS and TBW groups; however, the HCS group had greater satisfaction with implant-related symptoms and smaller incision than the TBW group. There was no difference in the presence of nonunion, delayed union, and articular incongruity. HCS fixation for medial malleolar fractures is not inferior to TBW fixation, while reducing implant-related symptoms. These findings suggest that HCS is a viable alternative for the fixation of medial malleolar fractures.

Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment

BackgroundThe optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction.MethodsFor this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated.ResultThis study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction.ConclusionFor treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.

Predicting secondary surgery after operative fixation of olecranon fractures: a model using data from 800 patients.

BackgroundHigh rates of secondary surgery after fixation of olecranon fractures have been reported. Identification of risk factors can aid surgeons to reduce complications leading to additional surgical procedures.MethodsOlecranon fractures treated at seven hospitals from 2007 to 2017 were identified, and the radiographs were classified. Isolated, displaced olecranon fractures treated operatively with tension band wiring (TBW) or precontoured plate fixation (PF) were reviewed. Adjusted risk factors for secondary surgery were analyzed, and a multivariable predictive model for secondary surgery was built.ResultsAfter the initial review of 1259 olecranon fractures, 800 isolated, displaced olecranon fractures met the inclusion and exclusion criteria. The distribution of two-part and multifragmented fractures was equal. TBW was used in 636 patients and PF in 164 patients. Multifragmentation was a significant variable influencing preference for PF. Secondary surgery was performed in 41% patients and symptomatic hardware removal was the most frequent primary indication. In both the TBW and PF group, the rates of major complications leading to secondary surgery were 13% (P = .96). The adjusted risk of secondary surgery was lower with increasing age (odds ratio by 10 years increments, 0.74; 95% confidence interval, 0.68-0.80, P < .01). Compared with PF, TBW with transcortical K-wires (odds ratio, 2.06; 95% confidence interval, 1.36-3.14; P < .01) and TBW with intramedullary K-wires (odds ratio, 4.32; 95% confidence interval, 2.16-8.86, P < .01) had significantly higher adjusted risk of secondary surgery.ConclusionSurgeons preferred to use PF in younger patients and multifragmented fractures. Patients should be counseled that secondary surgery is common after surgical fixation of olecranon fractures. Symptomatic hardware removal was the most frequently reported reason for secondary surgery and more frequent after TBW. When using TBW, intramedullary K-wire positioning should be avoided. The rate of major complications leading to secondary surgery was similar in the TBW and PF groups. Overall, the risk of subsequent secondary surgery was higher in younger patients and patients treated with TBW.

Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study.

The aim of this study was to compare the biomechanical properties of a hybrid external skeletal fixator (HESF) construct to the placement of paired interfragmentary Kirschner wires alone, and pin and tension band wire (PTBW) fixation for the stabilization of simulated tibial tuberosity fractures in dogs. Tibias were harvested from 12 skeletally mature dog cadavers weighing 20 to 30 kg. An osteotomy was made through the base of the tibial tuberosity, which was subsequently repaired with either paired Kirschner wires, PTBW fixation or a HESF. A tensile load was applied to the tibial tuberosity until failure occurred. Mode of failure was described and biomechanical parameters obtained were compared between fixation groups. The PTBW fixation and HESF construct afforded greater stiffness and load at 3 mm of axial displacement compared with fixation with Kirschner wires alone. There was no significant difference in stiffness and load at 3 mm displacement between PTBW and HESF fixation. Failure occurred by bending and pullout of the Kirschner wires for all fixation groups, preceded by untwisting of the knot in PTBW specimens. The HESF may provide a favourable alternative to PTBW fixation for tibial tuberosity avulsion fracture stabilization in dogs with substantial remaining growth potential.

Comparison of two surgical techniques for the treatment of transverse olecranon fractures: A finite element study.

In this study, we aimed to compare the stability of traditional tension band wiring (TBW) and screw combined TBW (SC-TBW) fixation methods performed for a transverse olecranon osteotomy-fracture during different degrees of elbow movement by using finite element analysis. Three-dimensional solid modeling of the olecranon was obtained by computed tomography images. Transverse olecranon fracture was created and fixed by TBW and SC-TBW with respect to triceps muscle force. Opening angle, twisting angle and interplanar translation occurring on the fracture line were evaluated at 45° and 90° elbow flexion. Opening angle: 0.71°, 0.87° at 45° and 0.64°, 0.67° at 90° elbow flexion for TBW and SC-TBW, respectively. Twisting angle: -0.01°, -0.19° at 45° flexion and 0.19°, 0.30° at 90° flexion for TBW and SC-TBW, respectively. Interplanar translation: 1.93mm, 4.65mm at 45° flexion and 1.78mm, 3.95mm at 90° flexion for TBW and SC-TBW, respectively. TBW fixation provides more stability than SC-TBW fixation model.

Comparison of the clinical efficacy of different fixation systems for the treatment of transverse patellar fractures

PurposeThis study was designed to compare the clinical efficacy of “8” and “0” wire fixation systems combined with double-head cannulated compression screws or Kirschner wires for the treatment of transverse patellar fractures. MethodsFrom September 2011 to September 2018, patients with closed transverse patellar fractures treated with a double-head compression screw or Kirschner wire were included and analyzed retrospectively. Patients with patellar fractures combined with distal femoral fractures, tibial plateau fracture or preoperative lower limb dysfunction were excluded. The patients treated with the “8” tension band wire fixation system and Kirschner wire were taken as Group A; those treated with the “0” fixation system and Kirschner wire were taken as Group B; those treated with the “8” fixation system and double-head cannulated compression screw were taken as group C; and those treated with the “0” fixation system and double-head cannulated compression screw were taken as group D. Six weeks and one year after the operation and every month from the third month after the operation until the fractures healed, an X-ray examination was performed to identify fracture healing. The time of fracture healing and postoperative complications of the four groups were compared. One year after the operation, knee function was evaluated by Bostman’s score. ResultsDuring the study period, 168 patients with patellar fractures were treated by operations, and 88 patients were excluded because the fracture type did not meet the requirements or because there were combined fractures of the distal femur or tibial plateau. As a result, 80 patients were included in this study, 20 in each group. All the patients were followed up for an average period of 12.2 months. Compared with Group A, patients in Group D presented less postoperative discomfort in the prepatellar region, quicker fracture healing, less fixation failure and better postoperative knee function scores (all p < 0.05). The incidence of internal fixation failure in Group (B+D) was lower than that in Group (A+C) (p > 0.05). ConclusionThe “0” wire fixation system combined with a double-head cannulated compression screw seems to be more beneficial than the other three fixation systems for the treatment of transverse patellar fractures.

Mini-Screws-Only Fixation Method for Small Fragments of Medial Malleolus Fractures.

BackgroudOpen reduction and internal fixation is the standard treatment for a displaced medial malleolus fracture (MMFx), achieving ankle stability and bony union to prevent post-traumatic arthritis. Previous fixation techniques including tension band wiring and unicortical screw fixation are not optimal for fixation of small fragments in MMFx due to their small size and poor manipulability. Here, we describe a novel surgical method using mini-screws only for fixation of small fragments in MMFx.MethodsWe conducted a retrospective consecutive study of patients who underwent surgery using mini-screws for small fragment MMFx between April 2013 and March 2018. We reviewed the patients' clinical characteristics and assessed the fracture features radiographically. Clinical outcomes were assessed by measuring the range of motion of both ankle joints and investigating symptomatic implants. We reviewed the radiographic outcomes of the medial malleolus and the functional outcomes using the Foot and Ankle Outcome Score (FAOS) at the last follow-up.ResultsNine patients were included in the study. The minimal follow-up period was 27 months. There was no incidental bone breakage during the procedure. All MMFx healed without reduction loss, nonunion, or implant failure at the last follow-up. Two patients had mild osteoarthritic changes of the ankle joint. The mean FAOS score of the patients was 80.99 (range, 65.44–98.42). No patients required removal of the hardware.ConclusionsFixation of comminuted fractures of the medial malleolus using mini-screws for young adult patients is a straightforward and simple technique. Safe fixation of the anterior and posterior colliculi reduces the risk of implant irritation symptoms that necessitate implant removal.

Comparison of double screw fixation versus tension-band fixation after olecranon osteotomy for complex distal humerus fractures

IntroductionSupra- and intercondylar elbow fractures are surgically challenging given the intra-articular comminution. Various surgical approaches have been described. Among these–olecranon osteotomy–provides optimal joint exposure but is associated with several complications. Tension band wiring (TBW) is the most commonly used fixation method. We hypothesized that double screw fixation would lead to fewer surgical revisions than TBW (all causes included) after olecranon osteotomy. MethodsWe carried out a single-center retrospective study of 39 patients, treated between January 2007 and April 2016, for a supra- or intercondylar elbow fracture using the transolecranon exposure. There were 34 type C fractures (13 C1, 6 C2 and 15 C3), 3 type B fractures and 2 type A fractures, based on the AO classification. Fourteen patients received double screw fixation and 25 received TBW. The primary outcome measure was the number of surgical revisions, regardless of cause. Secondary outcome measures were the number of surgical revisions for olecranon nonunion, fixation failure or fixation device removal due to pain. ResultsThere were significantly more surgical revisions in the TBW group than in the double screw fixation group: 3 (21%) versus 14 (56%) (p=0.049, Fisher test). The three main reasons for revision in the TBW and double screw fixation groups were removal of the fixation device due to soft tissue impingement (11 [44%] versus 2 [14%]; p=0.08), failure of the olecranon fixation (6 [24%] versus 1 [7%] p=0.38), and olecranon nonunion (4 [16%] versus 0 [0%] p=0.27). DiscussionThere are no published studies on the outcomes of this surgical technique. The posterior transolecranon approach provides the best exposure at the elbow joint. TBW fixation is associated with multiple complications. Double screw fixation for olecranon fractures yields good clinical and radiological outcomes. ConclusionBased on our findings, double screw fixation of the olecranon results in fewer surgical revisions (all causes combined) than TBW in supra- and intercondylar elbow fractures operated by a transolecranon approach. Level of evidenceIV.

Olecranon Osteotomy Implant Removal Rates and Associated Complications.

This study reports on olecranon osteotomy implant removal rates, fixation types, and associated complications. Multicentre case series. Patients were identified through an electronic medical database at one Level 1 trauma center and three Level 2 trauma centers. Two hundred thirty-five patients were identified through the database, of which 92 patients met inclusion criteria. Patients underwent olecranon osteotomy for fixation of distal humerus fractures and the implant used was at the surgeon's discretion. Implant removal rate. Thirty-four of 92 (37.0%) patients underwent removal of implant from their olecranon osteotomy. Implant removal rates were as follows: 28 of the 63 patients for tension band wiring (TBW) (44.4%), 6 of the 18 patients for plates (33.3%), 0 of the 1 patient for cable-pin, and 0 of the 10 patients for osteotomies fixed with a screw fixation. Screw fixation was removed less frequently than TBW (P = 0.01). Screws were less commonly removed than all other fixation types (P = 0.01). TBWs (28/63) were more commonly removed than all other implants (6/29) (P < 0.05). The nonunion rate for olecranon osteotomies was 3.3%. TBWs (18/18) are more likely to be removed for implant irritation than plates. TBWs had an odds ratio of 3.29 for requiring implant removal if they were left >1 mm off of the olecranon tip. In this study, 34 of the 92 (37%) patients undergoing an olecranon osteotomy for treatment of a distal humerus fracture required removal of olecranon implant. Screw fixation (0/10) was found to be removed less frequently than TBW fixation 28 of the 63 patients (44.4%). Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.