Tension band wiring of the olecranon: Is it really a dynamic principle of osteosynthesis?

Brink, Peter R.; Windolf, Markus; Boer, Piet de; Brianza, Stefano; Braunstein, Volker; Schwieger, Karsten

doi:10.1016/j.injury.2012.08.052

Cited by 61 publications

(42 citation statements)

References 18 publications

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“…They used six fresh frozen cadaveric upper limbs treated with tension band wiring and applied various loading protocols. None of the six fractures showed secondary dislocation, but the dynamic compression of the principle tension band was only achieved when the elbow was actively extended against gravity at between 30°and 120° [37].…”

Section: Discussionmentioning

confidence: 94%

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: 94%

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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“…In this study published by Flinterman et al, the authors provide insightful data on the long-term functional results following tension band wire fixation. The authors use validated outcome measures that allow for appropriate comparisons with other These results seem to contradict recent biomechanical reports that have questioned the biomechanical properties of tension band wire fixation constructs [2,6,10]. However, the presented data also emphasize that surgical fixation of olecranon fractures remains a challenging procedure and is associated with a very real risk of substantial complications.…”

Section: Where Do We Need To Go?mentioning

confidence: 79%

CORR Insights®: Long-term Outcome of Displaced, Transverse, Noncomminuted Olecranon Fractures

Zelle

2014

Clinical Orthopaedics &Amp; Related Research

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“…6 It has recently been shown that this principle is applicable only during active extension through a range of 30-120° of elbow flexion. 7 However, tension band wiring remains a popular method of internal fixation of olecranon fractures. 6 The advantages of tension band wiring compared with plate fixation include shorter surgery 4 and lower cost.…”

Section: Discussionmentioning

confidence: 99%

A survey of current practices and preferences for internal fixation of displaced olecranon fractures

Wood

Thomas

Farrokhyar

et al. 2015

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Background: Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons' practices and preferences for internal fixation methods for displaced olecranon fractures. Methods:Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures. Results:We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5-37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73-83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5-85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17-3.45) and comminution with a mean impact of 3.34 (95% CI 3.21-3.46) were the 2 factors influencing surgeons' choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69-80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4-81.7%) and 76.2% (95% CI 70.6-81.0%) for tension band wiring and plating, respectively. Conclusion:Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures.

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Tension band wiring of the olecranon: Is it really a dynamic principle of osteosynthesis?

Cited by 61 publications

References 18 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

CORR Insights®: Long-term Outcome of Displaced, Transverse, Noncomminuted Olecranon Fractures

A survey of current practices and preferences for internal fixation of displaced olecranon fractures

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