Tension band wiring tbw technique, one of the most commonly used surgical method in treating a tension fracture 7,8,9,10, has a sound. Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar. Introduction patella is the largest sesamoid bone and has an important role in function of the knee extensor mechanism. Although the kwire and tension band technique remains popular, patients frequently complain of discomfort secondary to prominent hardware, leading to high rates of removal of hardware roh. Patella fracture reduction and fixation using cannulated screws and tension band wiring by nyu langone orthopedics featuring dylan lowe, laith jazrawi january 2018. If displaced, it should be repaired surgically to restore the function of extensor mechanism and aid in fracture healing 5, 6. Horizontal versus vertical orientation of the loop for.
About one third of patella fractures require surgery, which is indicated if there is damage to the extensor mechanism or in fractures associated with 2. The most common configuration has parallel kirschner k wires. Tensionband wiring is commonly used to treat transverse patella fractures. Arthrex patella fracture fixation using cannulated. Oct 09, 2015 plate versus tension band wire fixation for olecranon fractures duration.
Comparison of a novel tension band and patellotibial. The patient underwent surgery by anterior approach where quadricepsplasty and tension band wiring for the patella were performed after bringing the superior fragment down figure 2. An example xray demonstrating fracture of the patella. The goal of this study was to assess the outcome and implant. Casebased instructional video discussing indications for tension band fixation of patella fractures with intraoperative instructions and surgical tips. Orif patella fracture postoperative rehabilitation protocol name. Gap formation was measured over 40 loaded flexionextension cycles 90 to 5. Open reduction and internal fixation using tension band wire technique using pins and wires and a figure of eight to press the pieces together pop cast in extension for 6 weeks. Depending on fracture stability motion will increase the interfragmentary compression. Anatomical features include the proximal articular body, with an. Comparison of the outcomes of cannulated screws vs. The use of tension band wire technique for patella fractures fixation is a wellestablished technique.
To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such. A tension band wire is a form of orthopaedic internal fixation method used to convert distraction forces into compression forces, promoting bone healing. Patella fracture, open reduction, internal fixation, tension band wiring, cerclage wiring. Pain, operating time, mobility, functional score, and complications were evaluated. Feb 19, 20 treatment options for comminuted patella fractures 21. Modified tension band wiring tbw, one of the most common surgical fixation methods for patellar. Ao foundation patella fracture tbw tension band youtube.
Tension band wiring is an optimal mechanical principle for early functional motion. Patella fracture orif with tension band trauma orthobullets. Percutaneous cannulated screws with tension band wiring. Tension band wiring with cerclage wiring is most widely used for treating displaced patellar fractures. Arthrex patella fracture fixation using cannulated screws. Efficacy of kwire tension band fixation compared with.
Oct 11, 2006 tension band wiring is commonly used to treat transverse patella fractures. Post surgically the leg is immobilised by cylindrical plaster cast immobilisation for 3 to 4 weeks. Ota video library orif patella fracture with tension band. In the 1950s, the technique of tensionband wiring was first described, and later biomechanical studies showed it to be superior to intraosseous wire suture. Pubmed and embase databases were searched for all relevant studies. Unfortunately in as much as 3040% of patients these wires can become problematic.
Register your interest and we will get in contact with you shortly. Factors affecting the outcomes of modified tension band. Biomechanical analysis of tension band wiring tbw of transverse. Displaced patellar fractures treatment options for lowerpole fractures or patellar tendon rupture polar 24. Implant removal following surgical stabilization of. Comminuted fracture circlage wire and k wirefixation 22. Modified tension band technique for patella fractures sciencedirect. Patella, fracture, tension band wiring, internal fixation introduction patella is the largest sesamoid bone in the body situated in front of knee. Other indications for tension band wiring greatertuberosity of humerus 25. Modified tension band technique for patella fractures. The tension band wiring technique is the most common method of transverse patella fracture fixation 1, 2, 5, 810.
Pdf percutaneous tension band wiring for patellar fractures. Patella fracture reduction and fixation using cannulated. It is surgically managed by tension band wiring around the knee. Although wire breakage is not uncommon, migration of a fragment of the broken wire is rare, especially migration into the knee joint. It involves longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior side of the patella. Treatment of displaced transverse fractures of the patella. The modified anterior tension band technique with kirschner wires kwires is one of the most common methods used for fixation of simple midpole patella fractures. Modified tension band wiring has been widely used to treat transverse patellar fractures. Tension band wiring tbw of patella is one of the most common and popular. Oliver, md, columbia, mo demonstrates patella fracture fixation using 4.
Tension band wiring for complete articular, frontalcoronal. Ota video library orif patella fracture with tension band construct on vimeo. Laith jazrawi of nyu langone orthopedics demonstrates patella fracture open reduction and internal fixation using cannulated screws and tension band wiring. To be able to use a tension band, the posterior articular cortex cannot be comminuted as it must provide a buttress to allow compression. Percutaneous tension band wiring for patellar fractures. The quadriceps produces significant forces on patellar fractures. Percutaneous tensionband suture technique for distal. Patella fractures account for 1% of all fractures but there is little in the contemporary literature regarding outcomes. Fixation of comminuted patellar fracture with combined. Another tension band wire was passed through the neutralization hole made just posterior to the tibial tuberosity and the retinaculum was repaired. K wire fixation with tension band wiring has conventionally been used for the open reduction and internal fixation of the patella. Operative treatment is recommended for displaced patellar fractures. Percutaneous tensionband suture technique for distal patella. This technique, although used widely, has certain distinct disadvantages.
Berg ee et al 14 shows that radiological union of transverse fracture of patella was seen at a mean age of week. However, few studies have evaluated the clinical outcomes using different methods of kirschner wire bending, location of the tension band, and depths of kirschner wires. Tension band wiring is a fixation technique which results in. It is accepted that where fixation is required it needs to be rigid and tension band wiring using cannulated screws or kwires is the accepted standard. Tensionband wiring of transverse fractures of patella. Tension band stitch for complete articular, frontal. Functional outcome with modified tension band wiring. Wires are used as tension band most commonly in patella and olecranon fractures. Comminuted patellar fractures usually occur with direct trauma. Doubletension wire management of nonunion patella with. The most commonly used technique for managing patella fracture fixation involves a modified tension band wiring technique 47 with longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior surface of the patella, through an extensile incision.
Conversely, if the compression increases with motion, such as in the patella with knee flexion, the tension band is called. From march 2016 to march 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two kirschner wires kwires and fiberwire. Multifragmentary patellar fractures cannot be fixed with a tension band. The tension band with the cannulated screw is the same as the k.
The cannulated screws compress the fracture and the blunt tips prevent lacerations to the fibertape. In the 1950s, the technique of tensionband wiring was first described, and later. The direct force often results in comminuted or due to violent contraction of. Historically, the most commonly used technique for managing patellar fracture fixation is represented by the modified tension band wiring technique 5, 19, 23. Surgical treatment of transverse patella fractures with this percutaneous cannulated screws with tension band wiring technique, which combined the advantages of rigid internal fixation and minimally invasive surgery, has shown to provide satisfactory clinical results and excellent knee functions, with less pain and low incidence of complications. Tension band for patella frx wheeless textbook of orthopaedics. Explain the principle of tension band wiring sum up the indications for tension band wiring. The wires help keep the bones together while they heal. If a tension band produces fairly constant force at the fracture site during motion, such as at the medial malleolus, it is called a static tension band. Tension band wiring is commonly used to treat displaced patella fractures.
Register your interest and we will get in contact with you. Plate versus tension band wire fixation for olecranon fractures duration. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to. Ota video library orif patella fracture with tension. Patella fracture, cerclage wiring, tension band wiring introduction patella fractures account for 1% of all skeletal fractures1. A century ago, a report of 1100 patella fractures clearly established operative internal fixation as the standard of care for displaced fractures of the patella. Orif patella fracture postoperative rehabilitation protocol. Management of comminuted patellar fracture fixation using. Cannulated screw prominence in tension band wiring of. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar fracture with. Undisplaced fracture is managed by cylindrical plaster cast immobilisation for 2 to 3 seeks.
The patella is the largest sesamoid bone in the human body. The use of tension band wire technique for patella fractures fixation is a. However, the standard technique, which involves using two kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. Wiring or technically tension band wiring of the patella is a common way to treat patella kneecap fractures. Patella, fracture, internal fixation, tension band wiring. In comminuted patellar fractures, we performed modified tension band wiring using a fiberwire arthrex instead of the conventional methods. The most commonly used technique for managing patella fracture fixation involves a modified tensionband wiring technique 47 with longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior surface of the patella, through an extensile incision. Cannulated screw prominence in tension band wiring of patella. Lumbar spine transverse process fracture everything you need to know dr. The combination of cerclage and tension band wiring proved to be significantly stronger and is recommended. For displaced fracture surgical intervention is a must.
Patella fractures, percutaneous wiring, functional outcome 1. Among all fracture types of the patella, transverse fracture of the body is the most common 1,2,3,4. May 03, 2017 wiring or technically tension band wiring of the patella is a common way to treat patella kneecap fractures. A fragment displacement of 2 mm was observed in 22%30% of the patients with early mobilization after tension band. Modified tension band wiring of patellar fracture as a. Implant removal following surgical stabilization of patella. Fiberwire tension band for patellar fractures springerlink. In the patella, an anterior figureofeight wire loop acts as a tension band during flexion of the knee. Nov 29, 20 although the modified tension band wiring is still the most frequently applied internal fixation technique for transverse patella fractures, postoperative symptoms and complications related to this technique are not uncommon. Although the modified tension band wiring is still the most frequently applied internal fixation technique for transverse patella fractures, postoperative symptoms and complications related to this technique are not uncommon. Early mobilisation is important but can cause detrimental displacement at the fracture site.
Tension band wiring of transverse fractures of patella. It is located within the extensor apparatus of the knee. Each patella was transversely osteotomized at its midportion and fixed with screws and an anterior tension band. To compare the efficacy and safety of kwire tension band fixation ktb with other alternative approaches cannulated screws, cable pin, and ring pin for treatment of patella fractures by performing a metaanalysis. Tension band wire for patella fracture touch surgery. Treatment options for comminuted patella fractures 21. Introduction patella, the largest sesamoid bone is located in the extensor apparatus of the knee which is. What goes on in a procedure for removing wires from around. Historically, the most commonly used technique for managing patellar fracture fixation is represented by the modified tensionband wiring technique 5, 19, 23. Tension band wiring for complete articular, frontal. To evaluate outcome of percutaneous tension band wiring for transverse fractures of the patella.
Patellar fractures account for approximately 1% of all skeletal fractures. Case reports in orthopedics hindawi publishing corporation. Other indications are tuberosity of the humerus, of the lateral. Fixation of patellar fractures is very crucial as it allows early. However, it suffers from distinct disadvantages such as implant irritation, need for open reduction, incidence of palpable implants, and need for subsequent implant removal. In the prominent screw group, screw length was 15% longer than the measured trajectory, resulting in 4 to 6 mm of additional length. A tension band can produce compression statically or dynamically. Transverse fracture of patella tbw tension band youtube. A smaller incision with percutaneous fixation may be an. Dec 20, 2017 tension band wiring application and principles fracture patella olecrnon greater trochanter medial malleoli clavicle slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The effect of site of wire twists and orientation of stainless steel wire loop.
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