This document discusses tension band fixation techniques for olecranon and patellar fractures. Tension band wiring is applicable for simple transverse fractures of the olecranon and patella. More complex fractures require alternative techniques like tension band plating or partial patellectomy. Total patellectomy should be avoided due to poor outcomes in less than 25% of cases. The goal of treatment is to restore the articular surface and preserve joint stability and range of motion.

1. AOTrauma Principles Course
Olecranon and patellar fractures
Peter Campbell, UK

2. Objectives
• Understand how the tension band principle is applicable
in fractures of the olecranon & patella
• Understand the limitations of tension band wire (TBW)
• Awareness of alternative techniques

3. Tension band principle
• Conversion of the tensile forces across a fracture into compressive
forces
• Fixation device placed eccentrically on tension side of fracture

4. Tension band principle

5. Olecranon and patellar fractures
• Treatment goals
• Restoration of articular surface
• Preservation of power of extension
• Joint stability
• Preservation of range of movement
• Avoidance of complications

6. Olecranon and patellar fractures
• Conservative treatment
• Undisplaced fractures, ie articular separation < 2mm
• No displacement with flexion
• Active extension

7. Classification of displaced olecranon
fractures
AO Müller Schatzker

8. Displaced olecranon—transverse
fractures
43-year-old, slipped on ice

9. Displaced olecranon—oblique fractures
Primary fixation with interfragmentary lag screw &
supplementary TBW

10. Displaced olecranon—complex fractures
• Require tension band plate—one-third
tubular/reconstruction plate

11. Displaced olecranon—complex fractures
• 54-year-old, fell off ladder
• One-third tibular plate

12. Displaced olecranon—complex fractures
• One-third tibular plate

13. Displaced olecranon—complex fractures
• 29-year-old, motorcycle accident
• Reconstruction plate

14. Displaced olecranon—complex fractures
• Reconstruction plate
postoperative

15. Displaced olecranon—complex fractures
6 months:
• Full rotation
• Full flexion
• 20° extension
• Normal function

16. Displaced olecranon fractures
• Management depends on fracture pattern
• Simple transverse—tension band wire
• Simple oblique— TBW + lag screw
• Complex— tension band plate + ?TBW
- Multifragmentary involving dorsal cortex
- Fracture distal to articular surface
- Fracture dislocation

17. Patellar fractures

18. Displaced patellar fractures

19. Displaced patellar fractures

20. Displaced patellar—transverse, simple
fractures
• 39-year-old, tripped

21. Displaced patellar—multifragmentary
(stellate) fractures
• 47-year-old, fell on steps

22. Displaced patellar fractures—
multifragmentary (stellate)

23. Displaced patellar fractures—partial
patellectomy

24. Displaced patellar fractures
Total patellectomy
• Scott, 1949, JBJS
• Einola et al, 1976, AOS
• Wilkinson, 1977, JBJS
• < 25% good/excellent result
• Preservation of one quarter will improve results

25. Summary
• Tension band fixation is a technique not a device and
the device required depends upon the fracture type
• TBW is recommended for simple transverse fractures,
although additional lag screws/cerclage wires will extend
its indications
• Complex fractures require alternative techniques:
- tension band plate
- partial patellectomy
• Avoid total patellectomy