Biomechanical comparison of bi- and tricortical k-wire fixation in tension band wiring osteosynthesis

Abstract

Background Patients with a simple transversal fracture of the olecranon are often treated with a tension band wiring (TBW), because it is known as a biomechanically appropriate and cost-effective procedure. Nevertheless, the technique is in detail more challenging than thought, resulting in a considerable high rate of implant-related complications like k-wire loosening and soft tissue irritation. In the literature, a distinction is generally only made between transcortical (bi-) and intramedullary (mono-) fixation of the wires. There is the additional possibility to fix the proximal bent end of k-wire in the cortex of the bone and thus create a tricortical fixation. The present study investigates the effectiveness of bi- and tricortical k-wire fixation in a biomechanical approach. Methods TBW of the olecranon was performed at 10 cadaver ulnas from six donors in a usual manner and divided into two groups: In group 1, the k-wire was inserted by bicortical fixation (BC), and in group 2, a tricortical fixation (TC) was chosen. Failure behavior and maximum pullout strength were assessed and evaluated by using a Zwick machine. The statistical evaluation was descriptive and with a paired t test for the evaluation of significances between the two techniques. Results The average age of the used donors was 81.5 ± 11.5 (62–92) years. Three donors were female, and three were male. Ten k-wires were examined in BC group and 10 in the TC group. The mean bone density of the used proximal ulnas was on average 579 ± 186 (336–899) HU. The maximum pullout strength was 263 ± 106 (125–429) N in the BC group and increased significantly in the TC group to 325 ± 102 (144–466) N [p = .005]. Conclusion This study confirms for the first time biomechanical superiority of tricortical k-wire fixation in the olecranon when using a TBW and may justify the clinical use of this method.

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

“…Tension band fixation used for fracture compression in orthopedic trauma surgery was preferred to provide epiphysiodesis in the present study. [15,16] We found that the tension band technique performed with K wire and cerclage could control the growth in the epiphysis by the aid of the compression created in the physeal growth plate of the subjects and was as effective as 8-plate. One of the hypotheses of the present study was to reduce the cost of the implants used in surgical procedures.…”

“…The tension band fixation provides an advantage for fracture union by converting tensile forces into compressive forces. [15,16] In the present experimental animal study, we hypothesized that the surface where the tension band application with the K-wire creates pressure on the perichondrial ring would be lower than the 8-plate and K-wire would cause less damage to the perichondrial ring. We, therefore, aimed to develop a lower-cost technique that prevents angular deformities, does not cause permanent problems, and minimizes damage by reducing the pressure in the perichondrial ring, by using the tension band technique with a K-wire and cerclage, which are commonly used by orthopedic surgeons in clinical practice.…”

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

“…This procedure ensures that the bone pieces are compressed dynamically and heal quickly. 5 Complications might arise, the most prevalent of which include hardware prominence that needs to be removed, mobility loss and fixation loss.…”

Biomechanical Comparison of a Novel Method of Tricortical Kirschner Wire Fixation of Distal Chevron Osteotomies of the First Metatarsal Versus Traditional Kirschner Wire and Versus Screw Fixation

“…A similar technique of utilizing tricortical wire fixation for olecranon fractures has shown biomechanical superiority to bicortical wire fixation. 13 The purpose of this study was to biomechanically compare the fixation of a distal chevron osteotomy using tricortical K-wire fixation with traditional unicortical K-wire fixation and singlescrew fixation. We hypothesized that tricortical K-wire fixation is biomechanically superior to traditional unicortical K-wire fixation and equivalent to screw fixation in a cadaveric model.…”

“…A similar technique of utilizing tricortical wire fixation for olecranon fractures has shown biomechanical superiority to bicortical wire fixation. 13…”