Proximal radio-ulnar synostosis complicating tension band wiring of the fractured olecranon

Velkes, Steven; Tytiun, Yehezkel; Salai, Moshe

doi:10.1016/j.injury.2004.12.034

Cited by 13 publications

(11 citation statements)

References 13 publications

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“…Over the years, minor changes have been applied to optimize the technique of TBW, and the intra-and postoperative complications appear to be low in both frequency and severity. In contrast to the prevailing opinion, several case reports highlight major risks, such as damage to the median and anterior interosseous nerves, vascular lesions in the ulnar artery, Volkmann's contracture, radio-ulnar synostosis, heterotopic ossification and restriction in mobility [13,14,17,22,[31][32][33]. Most of these complications occur when the K-wires surmount the far cortex of the ulna.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications in patients undergoing TBW are pain and the need for hardware removal due to migration of the K-wires and prominence of the hardware [2][3][4][5][6]. Other complications have been reported in different studies, including the loss of range of motion [7][8][9][10], degenerative changes of the elbow joint [11], nerve and vascular injuries [12][13][14], nonunions [15], heterotopic ossification [16,17] and infection [18,19]. The number of complications, including the high incidence of necessary hardware removals, and recurrently suggested surgical improvements in TBW raise the question of whether the current method is up to date or a critical review of the technique is required.…”

Section: Introductionmentioning

confidence: 99%

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

Schneider

Nowak

Bastian

et al. 2013

International Orthopaedics (SICOT)

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Purpose 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. Methods 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. Results 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.Conclusions 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.Level of Evidence: IV, treatment study

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Schneider

Nowak

Bastian

et al. 2013

International Orthopaedics (SICOT)

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“…3,5,11,33,35 Velkes et al reported the first 2 cases of radio-ulnar synostosis, which complicated the transcortical technique in isolated olecranon fractures. 34 Both radioulnar synostosis previously described occurred in the proximal forearm of the anterior ulnar cortex perforation of the K wires. In agreement with other authors, 5,6,24 the proposed mechanism for the synostosis is the calcification of the haematoma produced by the soft tissue trauma due to the passage of the K wires through the interosseus membrane and its surroundings.…”

Section: Discussionmentioning

confidence: 94%

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

Carli

Donndorff

Boretto

et al. 2009

Journal of Shoulder and Elbow Surgery

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“…In one report with two patients, clinical and radiological data were very limited [7]. In the second report, the patient presented 1 year after surgery with a complete block of pronation and supination [8].…”

Section: Discussionmentioning

confidence: 99%

“…However, non-union, infection, post-traumatic arthrosis, reflex sympathetic dystrophy and ulnar nerve palsy have all been described [2–4]. Reported cases of restricted forearm rotation [5, 6] and proximal radio-ulnar synostosis [7, 8] following TBW are less common, and the cases described offer little detail regarding the identification and management of these rare complications. We describe the management of a patient who presented with painful restriction of forearm movements and progressive proximal radio-ulnar synostosis due to heterotopic ossification following TBW of an olecranon fracture.…”

Section: Introductionmentioning

confidence: 99%

Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture

Karuppaiah¹,

Tahmassebi²,

Tavakkolizadeh³

et al. 2014

Strategies in Trauma and Limb Reconstruction

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A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30° on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6 months, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis

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Proximal radio-ulnar synostosis complicating tension band wiring of the fractured olecranon

Cited by 13 publications

References 13 publications

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

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

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

Management of heterotopic ossification and restricted forearm rotation after tension band wiring for olecranon fracture

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