the principle of tension band wiring and plating is beutifully illustrated through this presentation by dr mohamed ashraf,govt TD medical college,alleppey,kerala,india.how it works in certain fracture geometry,how it fails if the principle is not followed strictly through examples

1. Dr Mohamed ashraf
Prof and head
Govt TD medical college
Alleppey,kerala,india
drashraf369@gmail.com
TENSION BAND
PRINCIPLE AND PRACTICE

2. Importance of training
and teaching
The back bone of AO method is the careful
documentation of over 30000 operative cases which are
carefully followed up with over 250000 radiographs .
AO is totally able to prove / disprove hypothesis with
facts. A systematic analysis of failures has shown that
most of these were due to disregard for biomechanical
principles. This means that most failures are
preventable

3. AO philosophy
Anatomical reduction.
Stable internal fixation.
Preservation of the blood supply.
Early active pain free mobilization.

4. Unchanged philosophy
changing technics

5. Fracture fixation principles
changing scenario
• Absolute stability  Relative stability
• Mechanical fixation Biological fixation
• DCPLCPPC-LCPLOCKING PLATING
• UNLOCKED NAILINGLOCKED NAILING
TENSION BAND

6. PRINCIPLES OF AO METHODS
There are two principal methods of achieving
internal fixation
• Interfragmental compression.
• Splinting.
• Tension band-combines both
Each method has a best way of
achieving it and this is governed in part by
instrumentation.

7. Er.Frederic Pauwels-1935
Concept of load transfer in a cylindrical structure described

8. Bone under load
• Central loading [straight bone]
only compressing force
• Eccentric loading[curved bone]
tension force [tension side]
compression force [compression side

9. Femur tension and compression side

10. If cylinder [bone] broken
• No more force force transmitted
• If you band the tension [convex] side
• Then if force transmitted
• Force is converted to compressive force
especially on concave [compression] side

12. Tension band-biomechanics
• The implant alone doesn’t provide stability
• Along with deforming muscles it exerts
compressive force across fracture site
• Parallel K wires serve as rails for guided
compression

13. Avulsion fractures
management issues
Small fragments
Often displaced
Static pull by ligaments
Dynamic pull by muscles
Tremendous force across

14. 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.
4.INTACT SOFT TISSUE FOR TRANSMITTING
FORCE
PREREQUISITES OF TENSION
BAND FIXATION

15. TENSION BAND
PREREQUISITES

16. Fracture geometry
transvers
oblique
spiral
Fragments
segmental
comminuted
Bone strength porosis
PRE REQUISITES
FRACTURE PERSONALITY!

17. Tension band pre requisites
implant

18. Implant strength
• Steel wire patella 1-1.25 mm
• medial malleolus-0.8-1 mm
• lat malleolus-0.8 mm
• K wire patella 1.8-2mm
• malleoli 1.6 mm
• olecranon 1.6mm

19. Plate –pre requisites
• Strength
• Shape
• Pre stressing

20. Role of soft tissue
• Intact and functioning tendons [dynamic TB]
• Anatomically and physiologically funtioning
ligaments [static TB]
• Intact soft tissue and periosteal sleeve

21. TECHNICAL ASPECTS

22. BAND APPLICATION-WHERE

23. Surgical applications
• Long bone diaphysis have clear tension
and compression sides
• Patella and metaphyseal regions may not
have clear and defined sides
• Irregular bones calcaneum

24. SURGICAL APPLICATION
LONG BONES

25. TENSION BAND PLATING
BONE TENSION SIDE PLATING SIDE
FEMUR ANTEROLATERAL POSTEROLATERAL
TIBIA ANTERIOR LATERAL/MEDIAL
HUMERUS POSTERIOR ANTEROLAT/POST
RADIUS RADIAL[VARY] RADIAL/VOLAR
SACRUM POSTERIOR ANTERIOR/POSTERIOR

26. Surgical application
patella

27. patella
• Inside out
• Outside in
• Parallel k wires 2-2.5 cm apart[middle 2/3]
• 5mm deep to ant surface
• More close to articular surface-better

28. Patella tbw
Follow the technical aspects
to get the optimal results

29. Surgical application
olecranon
Commonest upperlimb fracture for TBW

30. olecranon
• K wire-anterior cortical penetration better
• If screw used-6.5 mm CCS with washer
32 mm thread
cross the # line by 7 cm

31. Olecranon-tbw

32. SURGICAL APPLICATION
MALLEOLI

33. Lateral malleolus
• Wire hole or anchoring screw-3cm proximal
to #line
• K wire tip 2 cm proximal to screw or wire

34. Surgical application
other area
• Trochanter
• Tuberosities
• Spine
• pelvis

35. Tension band is an optimal mechanical
principle
Can be applied to many selected
fracture situations-TBW , TBP
If applied properly ,it is a strong implant
construct
Active and passive mobility must be
ensured for optimal results

37. Dr mohamed ashraf
MBBS [ GMC CALICUT]
DORTHO [GMC TRIVANDRUM]
MS ORTHO [MMC MADRAS]
DNB,MNAMS[ NEW DELHI]
drashraf369@gmail.com