Tension band wiring

Tension Band Wiring (TBW) is a surgical technique widely used in the treatment of fractures, particularly those involving the patella, olecranon, and other small bones. It is a method that transforms tensile forces into compressive forces on the opposite cortex of the bone, which is essential for the healing process. This technique is especially beneficial for avulsion fractures where a fragment of bone is separated by the pull of a ligament or tendon.

Indications

Tension band wiring is primarily indicated for fractures in areas subjected to tension forces, such as the anterior surface of the patella or the tip of the olecranon. It is most effective in transverse or short oblique fractures. The main criteria for using TBW include:

• Avulsion fractures
• Transverse fractures of the patella and olecranon
• Small bone fractures where compression can aid in healing

Procedure

The TBW procedure involves the placement of wires and sometimes pins in a configuration that converts tensile forces into compressive forces at the fracture site. The steps generally include:

1. Reduction of the fracture to align the bone fragments.
2. Drilling of Kirschner wires (K-wires) across the fracture site to maintain alignment.
3. Wrapping a stainless steel wire in a figure-of-eight configuration around the K-wires and tightening it to apply compression across the fracture site.

The tension band effectively neutralizes the forces acting on the fracture site, allowing for proper healing with reduced risk of displacement.

Complications

As with any surgical procedure, tension band wiring can have complications, although they are relatively rare. These may include:

• Wire migration or breakage
• Infection at the surgical site
• Nonunion or delayed union of the fracture
• Irritation of the surrounding soft tissue

Postoperative Care

Postoperative care involves immobilization of the affected limb to ensure proper healing, followed by a gradual increase in movement and strength exercises. The duration of immobilization and the specific rehabilitation protocol may vary depending on the fracture's location and severity.

Advantages

The advantages of tension band wiring include:

• Minimally invasive technique
• Preservation of blood supply to the bone fragments
• Effective stabilization of the fracture, allowing for early mobilization

Disadvantages

Disadvantages of the technique may include:

• Risk of hardware irritation, necessitating removal after healing
• Not suitable for all types of fractures

Conclusion

Tension band wiring is a valuable technique in orthopedic surgery for treating specific types of fractures. Its ability to convert tensile forces into compressive forces at the fracture site promotes efficient healing. However, the technique's success depends on proper patient selection, surgical skill, and adherence to postoperative care protocols.