David B. Weiss, MD University of VA SEFS Durham, 2016
University of Virginia Orthopaedic Surgery
Disclosures
• Elsevier- Royalties
• METRC- Site PI
• Depuy/Synthes- ORP Course Chair
• AO North America- Lecturer
University of Virginia Orthopaedic Surgery
Learning objectives
• Understand the classification of olecranon fractures
• Review the concepts of tension band fixation
• Understand the indications for using tension band
• Review the technique of tension band wiring
University of Virginia Orthopaedic Surgery
Biomechanics
• Tension Band Theory
– When physiologically loaded, bone has tensile and compressive sides
– Goal is to convert tensile forces into compressive forces
University of Virginia Orthopaedic Surgery
Biomechanics
• Implant on tension side of bone
• Fracture pattern stable in compression – Intact or reconstructable cortical
buttress on compression side
• Bone able to withstand compressive forces – osteopenia
• Implant sufficient to resist tensile forces applied at fracture site
University of Virginia Orthopaedic Surgery
Absolute Stability
• Combination of implant and fracture produces compression and allows healing by cutting cones, no callus
• Key is obtaining stability at time of fixation with implant
University of Virginia Orthopaedic Surgery
Why do it?
• Lots of options for olecranon
• Is there truly a gold standard?
University of Virginia Orthopaedic Surgery
Why do it?
• Cost
– Plate + screws
• $100’s-1000’s
– Nail
• Thousands
– K wires + luque wire
• $10’s
University of Virginia Orthopaedic Surgery
Why do it?
• Austere environment
– Military
– Medical missions
– 3rd world environment
– Dropped tray of plates on floor
University of Virginia Orthopaedic Surgery
Outcomes
Reviewed 20 fractures treated with TBW All healed 16 had HW prominence 4 skin breakdown 1 infection Noted attention to technique important
University of Virginia Orthopaedic Surgery
-NYU-retrospective database review 23 with tension band wiring, 25 with hook plate -Incr time to union and slight decr terminal extension for hook plate
University of Virginia Orthopaedic Surgery
Utilized 4 k wires and 2 tension bands for Stiffer construct biomechanically and no Hardware failure clinically in 21 patients
University of Virginia Orthopaedic Surgery
Summary
• Tension Band wiring is an effective and inexpensive tool for appropriate fracture patterns in the olecranon (and elsewhere)
• Attention to detail on technique helps decrease hardware related complications
• Proven technique with lots of evidence to support efficacy
• Still useful in our quiver of more modern implants