TENSION BAND WIRING PRINCIPLES

1. By
Dr Salihi Abdulmalik
National Orthopaedic Hospital Dala-Kano
20th February, 2021

2.  Pauwel; curved tubular structure when
subjected to an axial load always present a
tension side on the convexity, compression
side on the concavity
 Same seen in a straight bone that is
eccentrically loaded

3.  Applying a tension band device laterally
(convex side) converts the tensile forces to
compression forces provided the opposite
side is stable and has good contact
 Where muscle pull tend to displace
fragments; olecranon, patella or avulsion
fracture of greater tuberosity, and greater
trochanter

4.  A tension band will neutralize the distraction
forces
 Under flexion of the joint the fragments will
be compressed
 Absolute stability, flexion exercises possible

5.  The tension band device must withstand
tensile forces
 The bone must resist compression
(osteoporotic bone, metabolic bone diseases
contraindicated)
 The cortex opposite to the tension band must
be exactly reduced without a gap

8.  Indications
◦ Transverse patella fracture
◦ Comminuted fracture that can converted to
transverse
◦ Displaced fracture
 > 3 mm displacement
 >2mm intra articular affectation

9.  Contraindications
◦ Osteoporotic bone
◦ Metabolic bone disease
◦ Missing bone on the concave (compression) side

11.  Figure of 8 is superior in neutralizing tension
forces
 Figure of 0 (Magnudson wiring) has more
stability against torsion force though with
risk of cerclage wire cutting into the
retinacula

12.  Pre op
◦ X rays
◦ FBC, U/E/Cr, GXM
◦ Consent
◦ Sand bag
◦ Pointed reduction clamps
◦ 1.6-2mm k-wires

13.  pre op
◦ 18-gauge (or 1.0-1.25mm) circlage wire
 To avoid bending of k-wire, circlage wire should be at
least 2mm less than the k-wire
◦ +/- mini fragment screws
◦ Suture passer
◦ Power drill

14.  Intra op
◦ Anaesthesia
◦ Prophylactic antibiotics
◦ Positioning
◦ Sand bag under the hip to prevent external rotation
of the limb
◦ 2 bolsters

15.  Anterior longitudinal midline incision
 Avoid unnecessary undermining of tissue
 Expose fracture and clear debris
 Assess degree of injury and define fracture
pattern
 Attempt reduction of fracture with pointed
reduction clamp

16.  Pass k-wires
◦ Antegradely (outside-in technique)
◦ Parallel
◦ Divide the patella into medial, central and lateral
thirds
◦ 5mm deep to the anterior aspect of the patella
◦ Protrude beyond patella and quadriceps tendon
◦ Perform arthrotomy
 Assess adequacy of reduction
 To remove pieces of bone/cartilage in the joint
 Examine the trochlear

17.  18-circlage wire
◦ Beneath patellar tendon
◦ Cross limbs of wire over anterior patella
◦ Pass wire transversely through quadriceps tendon
behind the K-wires
◦ Tighten wires by twisting both limbs of the wire
simultaneously (minimum of 3 turns to avoid
breakage) after applying tension

18. ◦ Wire should be close to the bone as possible
◦ Check reduction by palpating
◦ Bend ends of K-wires 180 degree anteriorly
◦ Cut excess K-wire
◦ Turn remaining end to face posteriorly
◦ Impact bent ends of K-wires into the patella

19.  Repair retinacular tears with multiple
interrupted sutures
 Arthrotomy is copiously irrigated and closed
in water-tight fashion
 Close wound

20.  Post op
◦ Analgesics
◦ Antibiotics
◦ Post op x ray
◦ ROM exercises
◦ Weight bearing as tolerated on day 1 post o
◦ 2-3 weeks wound heals

21.  Intra op loss of reduction
 Malreduction
 Asymmetric wire tension
 K-wire migration
 Prominent hardware
 Intra-articular penetration
 Wound breakdown