Tension band wiring is a surgical technique that uses wires and sometimes plates to stabilize fractures by converting distractive forces into compressive forces across the fracture line. It works by using parallel wires that act as rails to guide bone fragments into compression when muscles contract. The technique is commonly used for fractures of the olecranon, patella, and greater tuberosity that see eccentric loading and are prone to displacement without internal fixation.

1. Indian Pre-Basic Course:
Tension Band Wiring
DR DEEPAK K RAI
YENEPOYA MEDICAL COLLEGE
MANGALORE.

2. Biomechanics – Pauwels 1935

3. Biomechanics

4. Biomechanics

5. Biomechanics

6. Biomechanics
The cortex from the TBW must be strong enough to bear
the applied compressive loads

7. Biomechanics
The implant alone does not provide stability. In combination with
antagonistic deforming muscles, it can help produce uniform
compression at the fracture site. It guides the compression force.
The parallel wires serve as rails along which the bone fragments
slide.

8. Biomechanics
Tension Band Wiring is a device, which convert distraction
forces of extensors acting on the fracture line into
compressive forces

9. PREREQUISITES OF TENSION BAND FIXATION
1 . A PLATE OR WIRE THAT IS ABLE TO WITHSTAND
THE TENSILE FORCES.
2 . BONE WHICH IS ABLE TO WITHSTAND A
COMPRESSIVE FORCE.
3 . AN INTACT BUTTRESS OF THE OPPOSITE CORTEX.

10. Clinical Applications of tension band wiring
Greater
Olecranon tuberosity
Lateral
malleolus
Greater trochanter Patella

11. Anatomy of Olecranon and Patella- eccentric forces

12. Classification of olecranon fractures – AO and
Schatzker

13. Transverse olecranon fracture

14. Transverse impacted fracture

15. Oblique fracture – fixation with lag screw and tension
band wire

16. Comminuted fracture- tension band plate and lag
screw

17. Displaced fractures of patella should be treated
surgically

18. Displaced patellar fractures – classic figure of eight
tension band wire fixation
Transverse, simple
S.W. 39yo. Tripped

19. Highly comminuted patellar fracture

20. Treatment options for comminuted patella fractures

21. Comminuted fracture –circlage wire and K wire
fixation

22. Tension Band Wiring step by step

23. Displaced patellar fractures- treatment options for lower
pole fractures or patellar tendon rupture
Polar

24. Other indications for tension band wiring- greater
tuberosity of Humerus

25. Further indications for tension band wiring – greater
trochanter of femur

26. Summary
Tension Band Wiring is a device, which convert distraction
forces of extensors acting on the fracture line into
compressive forces

27. Summary
The implant alone does not provide stability. In combination with
antagonistic deforming muscles, it can help produce uniform
compression at the fracture site. It guides the compression force.
The parallel wires serve as rails along which the bone fragments
slide