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David B. Weiss, MD
University of VA
SEFS Durham, 2016
University of Virginia Orthopaedic Surgery
Disclosures
• Elsevier- Royalties
• METRC- Site PI
• Depuy/Synthes- ORP Course Chair
• AO North America- Lecturer
University of Virginia Orthopaedic Surgery
trauma clinic
“It really hurt to get my cast off”
University of Virginia Orthopaedic Surgery
Learning objectives
• Understand the classification of olecranon fractures
• Review the concepts of tension band fixation
• Understand the indications for using tension band
• Review the technique of tension band wiring
University of Virginia Orthopaedic Surgery
Mayo Classification
University of Virginia Orthopaedic Surgery
Eastwood Classification
University of Virginia Orthopaedic Surgery
Olecranon fractures
• Good
University of Virginia Orthopaedic Surgery
Olecranon fractures
Bad
University of Virginia Orthopaedic Surgery
Olecranon fractures
Ugly
University of Virginia Orthopaedic Surgery
Biomechanics
• Tension Band Theory
– When physiologically loaded, bone has tensile and compressive sides
– Goal is to convert tensile forces into compressive forces
University of Virginia Orthopaedic Surgery
Biomechanics
University of Virginia Orthopaedic Surgery
Olecranon
University of Virginia Orthopaedic Surgery
Biomechanics
• Implant on tension side of bone
• Fracture pattern stable in compression – Intact or reconstructable cortical
buttress on compression side
• Bone able to withstand compressive forces – osteopenia
• Implant sufficient to resist tensile forces applied at fracture site
University of Virginia Orthopaedic Surgery
Banana
University of Virginia Orthopaedic Surgery
Principles are important
University of Virginia Orthopaedic Surgery
Tension band
University of Virginia Orthopaedic Surgery
Absolute Stability
• Combination of implant and fracture produces compression and allows healing by cutting cones, no callus
• Key is obtaining stability at time of fixation with implant
University of Virginia Orthopaedic Surgery
Options for fixation
Tension band lag screw
University of Virginia Orthopaedic Surgery
Options for fixation
Plates of varying shapes and design
University of Virginia Orthopaedic Surgery
Options for fixation
Nail
University of Virginia Orthopaedic Surgery
Technique
Attention to detail important
University of Virginia Orthopaedic Surgery
Why do it?
• Lots of options for olecranon
• Is there truly a gold standard?
University of Virginia Orthopaedic Surgery
Why do it?
• Cost
– Plate + screws
• $100’s-1000’s
– Nail
• Thousands
– K wires + luque wire
• $10’s
University of Virginia Orthopaedic Surgery
Why do it?
• Austere environment
– Military
– Medical missions
– 3rd world environment
– Dropped tray of plates on floor
University of Virginia Orthopaedic Surgery
Outcomes
Reviewed 20 fractures treated with TBW All healed 16 had HW prominence 4 skin breakdown 1 infection Noted attention to technique important
University of Virginia Orthopaedic Surgery
-NYU-retrospective database review 23 with tension band wiring, 25 with hook plate -Incr time to union and slight decr terminal extension for hook plate
University of Virginia Orthopaedic Surgery
Utilized 4 k wires and 2 tension bands for Stiffer construct biomechanically and no Hardware failure clinically in 21 patients
University of Virginia Orthopaedic Surgery
Summary
• Tension Band wiring is an effective and inexpensive tool for appropriate fracture patterns in the olecranon (and elsewhere)
• Attention to detail on technique helps decrease hardware related complications
• Proven technique with lots of evidence to support efficacy
• Still useful in our quiver of more modern implants
University of Virginia Orthopaedic Surgery
Summary
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