Alternative tension band technique for olecranon fractures: A biomechanical study

Singh, Sanjit; Kuiper, Jan; Behzadian, Abol; Madhusudhan, T.; Sinha, Amit

Abstract

Objectives: To investigate whether an alternative tension band wire technique will produce greater compression and less displacement at olecranon (elbow) fracture sites compared to a standard figure of eight tension band technique. Olecranon fractures are commonly treated with tension band wiring using stainless steel wire in a figure of eight configuration. Tension band wiring is intended to produce compression across the fracture even during active flexion and extension of the elbow thus allowing early rehabilitation of the injured elbow. However recently published studies have raised doubts over the validity of the tension band concept proving that the standard figure of eight configuration does not provide fracture compression when the elbow is flexed. We propose an alternative tension band technique where the figure of eight is applied in a modified configuration.

Methods: An artificial elbow joint was simulated using artificial forearm (ulna) and arm (humerus) bones. The design simulated the action of the muscles around the elbow joint to produce flexion and extension. An intra-articular fracture was created in the ulna with a saw. Two 1.6 mm Kirshner wires were inserted to hold the reduced fracture fragments. This was followed by application of the tension band. There are two arms to this investigation:
(1)
Standard tension band wire configuration with stainless steel

(2)
Modified tension band wire configuration with stainless steel


The simulated elbow was put through a range of movement and sensors measured the compression at the fracture site. Measurements were taken for compression both at the articular and the non-articular aspect of the fracture. Three different weights were applied to challenge both the techniques of tension band wiring.

Results: Measurements from the non-articular surface of the fracture demonstrated greater compression with alternative tension band technique. However it was not statistically significant (ANOVA). Compression at the articular surface of the fracture exhibited statistically significant (p < 0.05) greater compression with the alternative technique. Neither technique produced greater compression during flexion of the simulated elbow.

Conclusions: The alternative tension band wiring technique proved superior in providing greater compression over the fracture site and smaller displacement. Clinical studies required to investigate whether this translates into higher union rates and lower metal work loosening.

Citation

Singh, S., Kuiper, J., Behzadian, A., Madhusudhan, T., & Sinha, A. (2016). Alternative tension band technique for olecranon fractures: A biomechanical study. Injury, 47(2), 294-295. https://doi.org/10.1016/j.injury.2015.12.008

• Journal Article Type: Article
• Publication Date: 2016-02
• Deposit Date: Jun 7, 2023
• Journal: Injury
• Print ISSN: 0020-1383
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 47
• Issue: 2
• Pages: 294-295
• DOI: https://doi.org/10.1016/j.injury.2015.12.008
• Keywords: Orthopedics and Sports Medicine; Emergency Medicine
• Additional Information: This article is maintained by: Elsevier; Article Title: Alternative tension band technique for olecranon fractures: A biomechanical study; Journal Title: Injury; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.injury.2015.12.008; Content Type: simple-article; Copyright: Copyright © 2015 Published by Elsevier Ltd.