Tension Band Wiring Technique Research Articles

Treatment of displaced transverse fractures of the patella: modified tension band wiring technique with or without augmented circumferential cerclage wire fixation

BackgroundDisplaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically. The most common method is a tension band wiring (TBW) technique. Some surgeons concurrently employ an augmented circumferential cerclage wiring (ACCW) technique to help fracture stabilization and aid in fracture healing; however, its role and effect on the treatment outcomes is unclear.MethodsWe performed a STROBE-compliant retrospective observational cohort study on all cases of acute closed patella fracture that were treated at our institution between 2006 and 2012. Of 185 episodes, 72 (38.9%) were eligible for this study according to our inclusion/exclusion criteria. We classified these subjects with AO/OTA type 34-C1.1 or 34-C2 lesions into two groups for analyses: fractures treated with modified TBW and ACCW (group 1, n = 27) and those treated with modified TBW alone (group 2, n = 45). Plain radiographs were used to evaluate radiographic outcomes and the effect of potential risk factors on fixation failure was analyzed by subgroup comparisons.ResultsOur results revealed that there were no significant differences in the rates of fixation failure (P = 0.620), nonunion (P = 0.620), and revision surgery (P = 0.620) between the groups. Although not statistically significant, there was a trend towards a positive risk association between fixation failure and age distribution > 60 years (10.0% vs. 0.0%, P = 0.124; OR = 8.0, P = 0.168) and > 70 years (9.4% vs. 2.5%, P = 0.321; OR = 4.0, P = 0.237) and the superficial level of the K-wires (12.0% vs. 1.5%, P = 0.117; OR = 6.3, P = 0.121). Regarding those modified TBW patients concurrently treated with an ACCW, the potential risk association between fixation failure and the superficial level of the K-wire was prone to increase further (28.6% vs. 0.0%, P = 0.060; OR = 18.6, P = 0.071).ConclusionsConcurrent application of an ACCW might be needless and not efficacious to help fracture stabilization and healing in patients having been treated with modified TBW for displaced transverse fractures of the body of the patella. Adherence to correct surgical technique such as putting the K-wires at the proper level and securing control of the both ends of the K-wires may be more important and help in improving outcomes.

An Observational Study on the Modified Tension Band Wiring Technique for the Management of Patients with Patella Fracture

An Observational Study on the Modified Tension Band Wiring Technique for the Management of Patients with Patella Fracture

Is the novel olecranon tension plate a valid alternative to tension band wiring of olecranon fractures? A biomechanical study on cadaver bones.

Tension band wiring (TBW) used for olecranon fractures is afflicted with a high rate of complications. The aim of this study was to compare the stability of the TBW versus an alternative, novel low-profile olecranon tension plate (OTP) with angular stable screws in a simulated complex fracture model. Nine fresh-frozen pairs of cadaver proximal ulnae with an oblique osteotomy and an additional wedge fragment simulating an unstable fracture were tested. The TBW and OTP were implanted pairwise. The elbow motion was simulated in a single-muscle model and ranged from full extension to 90° of flexion. The pulling force of the triceps tendon ranged from 50 to 200N. The displacement of the fracture fragments was measured with a video motion analysis system over 304 cycles. Data were assessed statistically using the Wilcoxon signed-rank test. The cyclic loading tests showed mean loosening of the fracture fragments at the articular surface of 0.56mm using TBW (SD 0.65) and 0.15mm for OTP (SD 0.39). There was no statistical significance in loosening between the two constructs (p=0.31). No plate breakage or screw loosening occurred. The low-profile OTP, using the principles of pre-tensioning, lag, cortical, and angular stable screws together, demonstrated similar stability after olecranon fracture fixation when compared with the TBW technique and a lag screw in the olecranon fracture model with a third wedge fragment.

A novel anatomical patellar plate for transverse patellar fracture – A biomechanical in-vitro study

ObjectiveThe aim of this study was to assess the safety and stability of our novel anatomical patella plate and to compare its stability with tension band-wire technique. MethodsA total of 12 cadaveric preserved knees (six right and six left patellae) with close patellar size were chosen to form two groups of six samples. Each group received either plate or tension band-wiring fixation for an experimentally created patella fracture. Cyclic load of an average of 350 N was applied for all specimens and after accomplishing 50 cycles the displacements of all fracture edges were recorded. ResultsAfter completing 50 cycles in each group, the average fracture edges displacement measured in the plate group was 1.98 ± 0.299 mm, whereas the average fracture edges displacement measured in the tension band-wire group was 2.85 ± 0.768 mm (p = 0.016). ConclusionIn the operative treatment of displaced transverse patellar fractures, the strength of fixation obtained by titanium curved plates is highly stronger when compared to the fixation with a tension band-wire technique. Fixation with titanium curved plates provides satisfactory stability at the fracture site which allow withstanding the cyclic loads during the postoperative rehabilitation.

Olecranon Osteotomy With Tension Band Wire Repair.

The purpose of this video is to demonstrate the surgical technique of olecranon osteotomy with tension band wire repair. A patient with a comminuted, intra-articular distal humerus fracture requiring ORIF is presented in this video demonstration of the surgical technique of an olecranon osteotomy. The olecranon osteotomy is an established technique for approaching the distal humerus for surgical repair of fracture. In the video, the patient is positioned laterally allowing a dorsal incision. The ulnar nerve is identified and protected. A chevron osteotomy, apex distally based, is created in the proximal ulna using osteotomes, centering the osteotomy within the sulcus of the proximal ulna. Once the osteotomy has been completed, the proximal ulna is reflected proximally to allow access to the distal humerus. The osteotomy is repaired using a tension band wire technique. The 2 longitudinal K-wires (0.062 inches) engage the volar cortex of the ulna and the tips of the pins are buried beneath the triceps tendon. A figure 8, 18-gauge cerclage wire is twisted to compress the osteotomy site at the end of the procedure to promote stability and healing. The video is 10 minutes, 30 seconds duration in time and 2,048,409,000 bytes in size. Various techniques of olecranon osteotomy have been described. The principles of a well-centered osteotomy and a stable repair are essential to this technique. This is demonstrated in the video of an olecranon osteotomy using osteotomes and a tension band repair.

Tension band wiring for proximal femoral varus osteotomy fixation in children.

For proximal varus osteotomy of the femur in children, a stable fixation, is a concern regarding the safety and the protection of the surgery. The methods of fixation are mostly represented by plating systems; however, the tension band wiring is a simple and eligible option for fixation of proximal femur osteotomy. The purpose of this retrospective case series study is to evaluate outcomes and bone remodelation after using the tension band wiring technique to fixate proximal femoral varus osteotomies in children.The study enrolled 20 patients who underwent femoral varus osteotomy to treat Legg–Calvé–Perthes disease and other causes of necrosis of the femoral head. The mean patient age at the time of surgery was 7.4 ± 2.3 years (range, 4.3–13.8 y), and the follow-up period averaged 10 ± 4.3 years (range, 4.7–20.8 y). To assess the effects of the osteotomy at the neck-shaft angle and its evolution over time, radiographs obtained preoperatively and during the follow-up were analyzed. The neck-shaft angle was measured independently by 2 observers, and intraclass correlation coefficients (ICCs) were assessed for reliability.The ICC analysis showed good reliability. There was a significant reduction in the neck-shaft angle (P < 0.001) between the preoperative and the immediate postoperative periods, with an estimated difference of 14.3°. Between the immediate and the early postoperative periods, the estimated difference was 2.1°, which indicated a significant increase in the neck-shaft angle (P = 0.003). Between the early postoperative period and the final evaluation, there was a significant increase (P < 0.001), with an estimated difference of 7.0°. No implant failures or other complications were observed, but 1 case of peri-implant femoral fracture occurred >17 years postsurgery.The tension band wiring technique proved to be a simple and effective method for fixating proximal femoral varus osteotomy in children.The level IV is appropriated for our study (case series, retrospective).

SIMULTANEOUS FOUR FINGER METACARPOPHALANGEAL JOINT FUSIONS – INDICATIONS AND RESULTS

To review the results and indications of simultaneous four finger metacarpophalangeal joint fusions. The clinical records and X-rays of nine patients undergoing the above procedure were reviewed. The indication for surgery was to reverse severe metacarpophalangeal joint flexion deformities in eight patients, and following a traumatic four finger amputation in one. Seven patients returned for follow-up assessment. The fusions were performed with a tension band wire technique, aiming for 20 degrees of flexion for index and middle fingers and 40 degrees in the ring and little fingers. Time to radiological fusion and position of fusion, and improvement in function and appearance were assessed. All joints were radiologically fused between six and 12 weeks. The average position of fusion of index and middle fingers was 20 degrees (range: 15-30) and ring and little fingers was 40 degrees (range: 35-50). Appearance was improved in all patients. Improved function was reported by four patients, and improved ease of hygiene and general care in four patients with non-functioning or poorly functioning hands. Simultaneous fusion of all four finger metacarpophalangeal joints may be considered as a primary procedure to reconstruct destroyed metacarpophalangeal joints due to inflammatory arthropathy or trauma, and for inability to correct deformity or maintain the correction with soft tissue procedures for patients with cerebral palsy, adult brain injury and arthrogryposis.

Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection.

The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique. This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning. On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91% of all cases), the use of a single wire knot (78%) and nonparallel K-wires (72%). Mayo IIa (n = 188) was the most common fracture type. Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated. IV, treatment study.

Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

IntroductionMost patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity.Surgical TechniqueThis study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures.Materials and MethodsWe performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score.ResultsThis technique has shown to provide satisfactory clinical results and excellent knee functions.ConclusionsThis technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Cancellous Screw with Tension Band Wiring for Fractures of the Olecranon

Olecranon fractures are one of the most commonly seen orthopaedic injuries in the emergency room. The K-wire which is used in the AO Tension Band Wiring (TBW) technique resists the shear better than the figure of eight wire alone, but, it does not add compression to the fixation strength. But, the cancellous screw plus the tension band wire, in combination, provides the strength of fixation i.e., by converting the tensile force to a compressive force at the fracture site, with additional resistance to the displacement due to the lag screw compression. To clinically evaluate the result of the cancellous screw with tension band wiring for fractures of the olecranon.To assess the elbow joint motion and stability after the procedure. Tweenty five cases of fractures of the olecranon which were treated by using 6.5mm AO cancellous screws with a screw length of 80-105mm with a 16 gauge TBW, were evaluated . All the cases were followed up and the results were analyzed by using a 19 point scale. The results which were obtained in our series were excellent in 15(60%) patients, good in 3(12%) patients and fair in 7(28%) patients and there were no poor results. The technique of open reduction and internal fixation with a 6.5mm AO cancellous screw and TBW, is a simple and effective means of treating fractures of the olecranon and it is based on the biomechanical principle of sound.

Clavicular Hook Plate: A Better Implant Choice for Fixation of Unstable Distal Clavicle Fractures?

Background The ideal fixation method for unstable distal clavicle fractures is still controversial. Clavicular hook plates (HPs) are an effective option but the clinical efficacy and advantages/disadvantages of this implant compared with the tension band wire technique in treating this fracture have not been determined. Methods A retrospective study was undertaken over a period of 3 years that included 45 patients, who were divided into two groups based on the treatment method. The clavicle HP group included 25 patients and the K-wire and tension band wire (KTBW) group included 20 patients. Radiographic examinations were taken to assess the adequacy of implant fixation and degree of bony union. Clinical results for pain, shoulder function and range of motion were evaluated using Constant–Murley scores. Results Two groups of patients were similar in terms of age, sex, injury mechanisms, time to surgery, and time of follow-up. The results showed that the HP group had a significantly higher union rate and lower occurrence of surgical complications (p Conclusions Although better surgical results and radiological outcome were achieved by using clavicle HP than KTBW in treating unstable distal clavicle fractures, the mechanical hook impingement imposed on the subacromial structures was remarkable and may have lowered the functional scores of patients receiving HP fixation. The result showed that clavicular HP did not offer more clinical advantages than with KTBW in treating unstable distal clavicle fracture.

Biomechanical Analysis of a Transverse Olecranon Fracture Model Using Tension Band Wiring

To determine (1) the most distal site at which a tension band construct can maintain bony alignment during dynamic loading of a transverse, length-stable olecranon osteotomy; (2) the location of displacement during cyclical loading; and (3) the ultimate load to failure of the fixation. We divided 23 non-osteoporotic, fresh-frozen upper extremities into 4 groups. We created transverse osteotomies at 25% of the olecranon surface in group 1, 50% in group II, 75% in group III, and 100% in group IV. We used standard tension band wiring technique to stabilize each osteotomy. We mounted specimens on a biomechanical testing machine at 90° elbow flexion and subjected them to a 150-N sinusoidal load through the triceps tendon at 1 Hz for 500 cycles. An optical motion tracking system synchronized with the testing machine-measured displacement of the osteotomy in any plane. On completion of cycling, we loaded specimens at 1 mm/s until 2-mm displacement occurred. We analyzed data to determine the effect of the location of the osteotomy on load to failure and location of displacement. Of the 23 specimens, 21 survived the cycling process. The 2 specimens that failed were both in group II (50%). Excluding these 2 specimens, the average displacement at the 3 virtual points was less than 1.05 mm in all 4 osteotomy groups. There were no statistical differences between groups. Load to failure was 476, 361, 511, and 610 N for groups I to IV, respectively. Differences between groups were not statistically significant. The stability achieved with tension band wire fixation did not vary with the location of the osteotomy. Based on this biomechanical study, when it is properly executed, tension band wire fixation may be used effectively for transverse, length-stable fractures of the olecranon regardless of the amount of articular surface included on the proximal fragment.

Fractures in Brief: Olecranon Fractures

Olecranon fractures are relatively common injuries, accounting for approximately 10% of upper extremity fractures in adults [26]. These fractures may result from a direct blow to the proximal ulna, or indirectly, via the forceful contraction of the triceps against resistance (typically, during a fall onto an outstretched hand). Less commonly, the olecranon may fracture when the elbow is hyperextended, as the bone is impacted against the olecranon fossa of the distal humerus. For unstable injuries, operative fixation typically is required. Even after recovery, loss of ROM is not uncommon. This article provides an overview of olecranon fractures in adults; therefore, discussion of olecranon fractures in skeletally immature patients is beyond the scope of this article.

Unusual Presentation Of An Aneurismal Bone Cyst In The Patella With Fracture – A Case Report

We report about a 25-year old man having an aneurysmal bone cyst in the patella presenting with fracture after falling from a height of 3 feet. He was asymptomatic before the fall. He was treated with curettage, bone grafting and internal fixation using tension band wire technique. Bone cysts are very unusual in the patella. Around 1% of primary bone tumours are aneurysmal bone cysts.(1) They are common in metaphyses of long bones of the lower extremity. Less than 1% of aneurysmal bone cysts occur in the patella.

K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures

Tension-band wiring (TBW) has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to examine the effect of K-wire position on instability of the K-wires in relation to local complications and radiological and clinical long-term outcome. We reviewed the early follow-up of 59 patients (mean age, 60 years) who underwent TBW osteosynthesis for displaced olecranon fractures. Follow-up information was available from medical records and radiographs. The main outcome measurements were proximal migration of the wires, gap, step, range of motion, and complications. Long-term follow-up included 21 patients (mean age, 58 years). Follow-up was available from a clinical visit and a radiograph. Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm Shoulder and Hand (DASH), EuroQol-5D (EQ-5D), and Broberg and Morrey osteoarthritis scores were obtained. Seventy-eight percent of the patients treated with intramedullary K-wires were found to have instability of K-wires, compared to 36% in the patients treated with transcortical K-wires. Patients with instability of the K-wires tend to develop osteoarthritis more often. There is a better functional outcome in patients where the osteosynthetic material is removed. Instability of K-wires after TBW is more common after intramedullary placement of the wires resulting in proximal migration of the K-wires and gap appearance. There was a tendency of more osteoarthritis in the group of patients where instability of K-wires was identified. We would recommend the use of transcortical placed wires, as well as to have a low threshold in removing the implants.

Technique modifiée du haubanage des fractures de la rotule

The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing of the figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, two case examples, and our case series are reviewed.

Modified tension band technique for patella fractures

The use of tension band wire technique for patella fractures fixation is a well-established technique. However, the standard technique, which involves using two Kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. Here we describe a modified technique using four Kirschner wires, which allows each wire to be bent, and well-impacted in order to avoid these problems. The basic surgical technique, and our case series are reviewed.

Proximal radio-ulnar synostosis and nonunion after olecranon fracture tension-band wiring: A case report

Fractures of the olecranon are the most common type of elbow fracture. Displaced fractures usually require operative treatment with open reduction and internal fixation to allow early motion in order to avoid significant stiffness of the elbow joint. Two parallel Kirschner wires inserted across the fracture into the medullary canal of the proximal ulna combined with a tension band wiring is a recognized and frequently performed method of fixation for noncomminuted fractures. Although isolated closed fractures of the olecranon in adults have a favorable long-term outcome, a few complications with this technique have been reported. The most common complication is migration of the K wires proximally leading to pain and local skin complications, with a high incidence (80%) of reoperation for the removal of symptomatic hardware. Therefore, this method has been modified so that the distal end of the Kirschner wires are inserted through the anterior cortex of the proximal ulna to prevent proximal wire migration postoperatively and to increase the stability of the tension band unit. The authors present a case of a patient with an isolated fracture of the olecranon that developed a proximal radioulnar synostosis and an olecranon nonunion associated with the use of the transcortical tension-band wiring technique. The possible mechanism for the synostosis formation, different from others described previously in accordance with the literature reviewed, will also be discussed herein below.

Fixation of Comminuted Patellar Fracture with Combined Cerclage and Tension Band Wiring Technique

In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %). Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.

Biomechanical Comparison of Dual Interlocking Single Loop and Double Loop Tension Band Techniques to the Classic AO Tension Band Technique for Repair of Olecranon Osteotomies in Dogs

To compare olecranon fragment stability between the classic tension band wire (TBW) technique with the wire placed either in contact with (Arbeitsgemeinschaft für Osteosynthesefragen [AO]), or not in contact with, a Kirschner (K)-wire (AOW) to 2 novel wire patterns: a dual interlocking single loop (DISL) and a double loop (DL). Ex vivo mechanical evaluation on cadaveric bones. Canine ulnae (n=40) with olecranon osteotomies repaired with 2 K-wires and 1 of 4 TBW constructs. Single load to failure applied through the triceps tendon. Displacement was measured from images captured from digital video. Techniques were compared based on the load resisted when the olecranon fragment was displaced 0.5, 1, and 2 mm. At 0.5 mm of displacement, the DISL construct resisted more load than the AOW construct (505 versus 350 N; P=.05). AO and DL constructs resisted an intermediate load (345 and 330 N, respectively). There was no significant difference between groups at 1 mm of displacement. At 2 mm of displacement, DL (785 N) resisted more load than AO (522 N, P=.01) and AOW (492 N, P=.03) groups. DISL constructs provided similar stability to classic TBW constructs whereas DL constructs were more stable at higher loads. The DL construct is easy to perform, less bulky, and provides comparable fragment stability to standard TBW techniques at functional loads. Surgical method is important for optimal performance of all TBW constructs.