The slack is then taken up by further twisting. Pass the long segment of the wire (bearing the loop) in a figure-of-eight configuration beneath the triceps tendon around the protruding ends of the K-wires. Exclude K-wire impingement of the radial ulnar joint. Both loops must be tightened at the same time and in the same direction, to achieve equal tension on both arms of the wire. AO modified this technique due to a high complication rate, notably proximal migration of Kirschner wires Remove the small pointed reduction forceps. The fracture is seen with the ends of the wire ready to be joined. The slack is then taken up by further twisting. AP and lateral X-rays of a displaced olecranon fracture in a 75 year old female. Prepare a 1.0 mm wire by making a loop approximately one third along its length. In order to be able to use a tension band, the anterior (far) cortex cannot be comminuted and must provide a buttress to allow compression. When tightening the screw make sure not to over compress the fracture. Register here. exsanguinate limb and inflate tourniquet if using tourniquet. Insert the drill guide over the first K-wire, and insert the second 1.6 mm K-wire parallel to the first one. Tension band principles. Therefore, multifragmentary fractures cannot be fixed with a tension band. Main indications. If the position of wires and fracture reduction is good, pull both K-wires back approximately 1 cm. For this procedure a posterolateral approach is normally used. Positioning the K-wires close to the joint while also penetrating the volar cortex is paramount. Other indications are tuberosity of the humerus, of the lateral and. Supine patient positioning with the arm placed across the chest. Insert the shorter segment of the wire through the drilled hole from medial to lateral. With the help of a pliers, bending iron and forceps, bend the proximal end of the K-wires 180 degrees. Bend the proximal end of the K-wires 180° with pliers, bending irons or forceps and cut the K-wires. 1. Delay exercises against resistance until healing is secure. Use of the elbow for low intensity activities is encouraged, but should not be painful. olecranon fractures. 12 weeks X-ray images with fractures healed. With the two wires cut, they are ready to be turned 180° and then impacted into the olecranon. As an alternative, one intramedullary screw or two intramedullary K-wires may be used instead of the two K-wires penetrating the anterior cortex. Usually, a screw of 10-12 cm length is appropriate. Equipment. The screw should cross the fracture site at least 7 cm. Posterior Approach to the Elbow. Join from wherever you are in the world. Reduce and hold the reduction of the transverse olecranon fracture with a small pointed reduction forceps. Tension band wiring. 1. As the ulnar nerve is medial it is safer to introduce the wire from this side. By tightening the twist and the loop with two pliers simultaneously, the two fragments are drawn together such that the fracture is placed under compression. Exclude K-wire penetration into the humeroulnar or radioulnar joint. December 3-6, 2020, Hip periprosthetic fracture module is now online. Cut the K-wires leaving a bend of about 5-6 mm. Positioning the K-wires as close to the joint while also penetrating the volar cortex is paramount. Leave enough space on the lateral side for the second K-wire. After fixing the distal humerus fracture, the olecranon fragment was stabilised with tension band wire technique. Aim the drill towards the anterior cortex, passing as close as possible to the joint. Prevent loading of the elbow for 6-8 weeks. Pearl: Drill a small unicortical hole in the distal fragment to secure the reduction forceps. Prepare the wire by making a loop approximately one third along its length. Alternative: Use a high-strength, braided composite suture or tape instead of figure-of-eight wire. Both loops must be tightened at the same time and in the same direction, to achieve equal tension on both arms of the wire. Loosely prepare the wire twist ensuring that each end of the wire spirals equally - the twist should not comprise one spiral around a straight wire. Other fixation methods leading where absolute stability is. Tension band fixation of olecranon fracture. screws. Aim the drill towards the anterior cortex, passing as close as possible to the joint. Using the drill guide, introduce the first K-wire medially through the olecranon apophysis. Approximately 40 mm distal to the fracture line and 5 mm from the posterior cortex, drill a hole through the ulna with a 2.0 mm drill, using a sharp drill guide as the drill tends to slide dorsally. Final x-rays or image intensifier views should demonstrate good reduction and proper hardware position. FIGURE 11-5. There is almost always a small spike on one of the fragment sides that exactly fits into a gap on the opposite fragment. The small pointed reduction forceps can now be removed. Ensure that each end of the wire spirals equally - the twist should not comprise one spiral around a straight wire. The post-operative management was similar to that of standard AO technique. The indications remained the same. The theoretical basis for tension band fixation of the olecranon is that it converts tensile forces on the posterior side of the olecranon into compression forces at the joint line during flexion. For this procedure a posterior approach is normally used. Make a stab incision through the triceps tendon insertion to place drill and screw. The philosophy behind the tension band for the olecranon is that it converts tensile forces on the posterior side of the olecranon into compression forces at the joint line during flexion. The ends of the K-wires have not been fully impacted into the olecranon. Choose the screw long enough to purchase in the inner cortex of the diaphyseal area. Note that one of the K-wires has backed out a little. identify ulnar nerve, tip of olecranon, ulna shaft, medial and lateral sides of elbow for orientation. Postoperatively, the elbow may be placed for a few days in a posterior splint for pain relief and to allow early soft tissue healing, but this is not essential. Insert the shorter segment of the wire through the drilled hole from medial to lateral. The second wire has been used a second figure of eight which has also been tightened with a twist on both sides. Encourage the patient to move the elbow actively in flexion, extension, pronation and supination as soon as possible. The fixation is simple and inexpensive and works well if executed properly. Equipment for tension band wiring of the olecranon: cerclage wire set (top left tray), 0.062-inch Kirschner wire (top right), large- and small-pointed reduction clamps (2) (bottom left), 14-gauge angiocatheter (bottom middle), and wire driver (bottom right). incision is along proximal ulna shaft, slightly wraps lateral to tip of olecranon, then … AO teaching video: Olecranon—transverse fracture 21-B1 tension band wiring. use scalpel dissection along subcutaneous border of ulna, centered about fracture site. There is almost always a small spike on one of the fragment sides that exactly fits into a gap on the opposite fragment.