Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study

Gruszka, Dominik; Arand, Charlotte; Nowak, T.; Dietz, Sven-Oliver; Wagner, Daniel; Rommens, Pol Maria

doi:10.1007/s00264-015-2703-0

Cited by 29 publications

(16 citation statements)

References 23 publications

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“…The bone density of all used proximal ulnas was 579 HU, which is slightly less comparable biomechanical studies. Gruszka et al evaluated in a comparison of TBW versus a novel olecranon tension plate (OTP) a mostly similar bone density of 694 HU for the OTP and 671 HU for the TBW group [2]. However, in the present study, the average age was 81.5 years higher than compared to Gruszka et al [2].…”

Section: Discussioncontrasting

confidence: 55%

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

Nowotny

Bischoff

Ahlfeld³

et al. 2019

Eur J Med Res

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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.

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Section: Discussioncontrasting

confidence: 55%

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

Nowotny

Bischoff

Ahlfeld³

et al. 2019

Eur J Med Res

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“…In previous studies in which bone models have been used, the materials used to simulate bone were more compliant, such as Delrin bar models or wooden patella models, introducing compliance within the testing structure that could potentially confound the mechanical property measurements of the constructs alone. Anatomical loading has been used similarly to our study in some previous studies, but, in those studies, K‐wires were inserted across the fracture gap for stability and thus did not isolate the performance of the wiring configurations under loading . Other researchers isolated the wiring configurations but did not perform anatomical loading .…”

Section: Discussionmentioning

confidence: 97%

Influence of wire configuration on resistance to fragment distraction of tension bands placed in a greater trochanteric osteotomy model

et al. 2019

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Objective: To determine the influence of wiring configurations on initial tension and resistance to tensile loads in tension band constructs without the contributions of Kirschner-wire stabilization.Study design: Experimental study. Sample population:A solid brass femur model manufactured on the basis of computed tomography of a normal right femur of a 30-kg dog modified by transection of the greater trochanter and placement of two pins that did not cross the simulated osteotomy.Methods: Four tension band configurations were applied to the metal trochanteric osteotomy model: figure-of-eight with one twist (OT), figure-of-eight with two twists (TT), dual interlocking single loop, and double loop (DL). Configurations were tested under both monotonic loading (n = 8 per configuration) and incremental cyclic loading (n = 8 per configuration). Initial tension after tying, residual tension remaining after each cycle, and failure load at 2 mm of displacement (considered equivalent to clinical failure) were compared between configurations. Results:The initial tension and the load to 2 mm of displacement were lower for OT wires compared with TT wires. The DL was the strongest and most stable configuration, generating 2.3 to 3.5 times greater initial tension, maintaining a greater percentage of residual tension under incremental cyclic loads, and resisting 2.0 to 2.4 times greater load before failure at 2 mm. Failure load was highly correlated with initial tension. Conclusion: Wire configurations reaching greater initial tension, such as the DL, allowed constructs to resist higher tensile loads. Clinical impact: Wire configurations allowing higher initial tension may be warranted when tension bands are expected to sustain high tensile loads.Elizabeth Thompson and Amir Robe are considered equal first authors, because they contributed equally to the study.

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“…Lots of biomechanical studies analysed simple olecranon fractures and their fixation with tension band wiring, intramedullary locking nails, fibre wire fixation or cancellous screws [ 14 , 17 , 19 , 20 , 25 , 26 ]. Studies, which simulated more complex proximal ulnar fractures, like in this presented study, are less frequent: intramedullary nail systems demonstrated a higher stability than the tension band wiring and the first-generation locking plates for the olecranon in comminuted fractures [ 11 , 18 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures

Hoelscher-Doht

Kladny

Paul

et al. 2020

Arch Orthop Trauma Surg

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Introduction Proximal ulna fractures are common in orthopaedic surgery. Comminuted fractures require a high primary stability by the osteosynthesis, to allow an early functional rehabilitation as fast as possible, to reduce long-term limitations of range of motion. Classical dorsal plating is related to wound healing problems due to the prominence of the implant. New low-profile double plates are available addressing the soft tissue problems by positioning the plates at the medial and lateral side. This study analysed whether, under high loading conditions, these new double plates provide an equivalent stability as compared to the rigid olecranon locking compression plate (LCP). Materials and methods In Sawbones, Mayo Type IIB fractures were simulated and stabilized by plate osteosyntheses: In group one, two low-profile plates were placed. In group two, a single dorsal plate (LCP) was used. The bones was than cyclically loaded simulating flexion grades of 0°, 30°, 60° and 90° of the elbow joint with increasing tension forces (150 , 150 , 300 and 500 N). The displacement and fracture gap movement were recorded. In the end, in load-to-failure tests, load at failure and mode of failure were determined. Results No significant differences were found for the displacement and fracture gap widening during cyclic loading. Under maximum loading, the double plates revealed a comparable load at failure like the single dorsal plate (LCP). The double plates failed with a proximal screw pull-out of the plate, whereas in the LCP group, in 10 out of 12 specimens the mode of failure was a diaphyseal shaft fracture at the distal plate peak. Conclusion Biomechanically, the double plates are a good alternative to the dorsal LCP providing a high stability under high loading conditions and, at the same, time reducing the soft tissue irritation by a lateral plate position.

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Olecranon tension plating or olecranon tension band wiring? A comparative biomechanical study

Abstract: The concept of replacing prominent K-wires at the proximal end of the ulna using an low-profile plate with classical lag and multidirectional angle-stable screws demonstrated biomechanical advantages over TBW.

Cited by 29 publications

References 23 publications

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

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

Influence of wire configuration on resistance to fragment distraction of tension bands placed in a greater trochanteric osteotomy model

Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures

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