mainly describing principles of tension band in managing fractures of the patella and olecranon - done for AO basic course in Bengbu, China

1. TENSION BAND – PRINCIPLES AND
INDICATIONS
Ahmad Fadzli Sulong – IIUM, Malaysia

2. At the end of this lecture you will be able to
understand:
• Principle of tension band wiring
• Indications for tension band wiring
LEARNING OUTCOMES

3. TENSION BAND PRINCIPLE
Concept introduced by Pauwels (an engineer)
An eccentrically loaded bone will always have a
tension side and compression side

4. TENSION BAND PRINCIPLE
A tension band converts a tension force into a
compressive force across the whole width of bone

5. TENSION BAND PRINCIPLE –
PREREQUISITES
• A simple fracture configuration that makes the
bone able to withstand compressive forces
• An implant (plate or wire) that can withstand
tensile forces
• An intact buttress on the opposite cortex

6. TENSION BAND PRINCIPLE
Even when put on tension side, an intact buttress still
needed in compression side for the tension band to work

7. TENSION BAND PRINCIPLE
• Fixation results in absolute stability
• If good interfragmentary compression is obtained
– direct bone healing will occur

8. TENSION BAND PRINCIPLE – TYPES
Dynamic tension band – produces increased
compression with motion

9. TENSION BAND PRINCIPLE – TYPES
Static tension band – already producing
compression at moment of reduction – remains
constant

10. Most commonly in patella
and olecranon fractures.
Others - tuberosity of the
humerus, lateral and medial
malleoli, trochanter of the
femur etc.
COMMON SITES OF USAGE

11. • Biomechanically an
inverted seesaw
• distal humerus – pivot
• triceps and brachialis
muscles – pull on
each side of the
proximal ulna
• Dorsal surface –
tension
• Ventral surface -
compression
OLECRANON

12. OLECRANON
• The tension band construct prevents opening of the
posterior (tension) cortex, the pull of the triceps and
brachialis results in compression across the whole
fracture plane.

13. PATELLA
• Femoral condyles – pivot
• Insertion of the quadriceps
and patellar tendons (onto
superficial surface of the
patella) – provides the load
• Superficial patella –
tension
• Deep surface of patella –
compression

14. SURGICAL TECHNIQUE?

15. TENSION BAND PRINCIPLE – PEARLS
Placement of wires ideally 5mm deep to the
anterior surface, will be close to joint– but will not
impair tension band principle if not.

16. TENSION BAND PRINCIPLE – PEARLS
Which one?
More stable against
torsional forces
Less likely to cut thru the
medial and lateral

17. TENSION BAND PRINCIPLE – PEARLS
What causes this?
How to prevent
it?

18. TENSION BAND PRINCIPLE – PEARLS
Know any
other
techniques?

19. TENSION BAND PRINCIPLE – EXAMPLES

20. TENSION BAND PRINCIPLE – EXAMPLES

21. TENSION BAND PRINCIPLE - AFTERCARE
• This principle is the ideal technique that requires
early mobilization for it to be effective
• Motion of the fixed bone would give better
compression promoting fracture healing to occur
• Early – passive
• Followed by active

22. SUMMARY
• Tension band principle is an effective fracture
fixation technique if all prerequisites are met
• Converts a tensile force into a compressive force
• Mainly used in fractures of the patella and
olecranon
• Implant does not confer stability rather the
movement of the affected part gives
compression and stability – thus early motion is
essential

25. Technique of tension band wiring
Olecranon fracture
A simple transverse fracture can be held
accurately by:
. 1) Inserting a K-wire through the
fracture line.
. 2) Inserting a second K-wire parallel to
the first one to prevent fragment
rotation.
.

26. Technique of tension band wiring
Olecranon fracture
. 3) The tension band is provided by a figure-
of-eight looped wire over the tension surface,
anchored around the K- wire ends proximally,
and a transverse hole through the ulna
distally.
The wire is tightened equally on both sides by
twisting to apply compression.
Once fixed, any pull on the triceps muscle
increases the dynamic compression across
the fracture site.

27. 1) Simple transverse fracture with
no fragmentation of the deep
articular cortex.
2) It can be reduced with pointed
forceps and held with two parallel
K-wires.
Patella fracture
Technique

28. 3) A wire, inserted around the
ends of these wires (deep to
the quadriceps tendon),
crossed over the front of the
patella, and then around the
lower ends of the K-wires is
tightened to provide
compression.
This achieved by tightening a
loop on each limb of the
wire.

29. 4) The pull of the quadriceps then
increases dynamic compression
across the fracture as the knee
flexes and extends.

31. Cerclage Wiring

36. These types of fractures, especially in
osteoporotic bone, are difficult to stabilize and
cerclage wiring does not provide adequate
biomechanical stability, although cerclage wiring
may be the only technique that will give any
stability at all.
If this surgical technique is used alone, it must
be supplemented with a period of postoperative
plaster, or thermoplastic, cylinder treatment of
the leg, or removable splintage.

37. Thank U