Tension band principls

National Orthopaedic Hospital Dala Kano,
Doctors breakfast presentation.

1. Discuss Tension Band principles By Dr Kabiru SALISU 11 th A ug. 2017

2. Outline Introduction Biomechanics of TB Indications Preoperative principles - Resuscitation - Establish indication - History - Examination - Investigation - Preoperative planning Intra-operative principles Anaesthesia Positioning Reduction Fixation - Wound closure Post operative Analgesia Wound care Physiotherapy Complications West African Perspective Conclusion

3. Introduction Tension Band is the principle of converting distraction (Tension force) forces acting on the fracture line into compressive force

4. Goals of TB To achieve anatomical reduction & compression To create absolute stability To achieve primary fracture healing

5. Introduction History Frederic Pauwel 1980

6. Biomechanics of TB

7. Prerequisite for Tension Band include; The implant must be able to withstand the tensile forces Bone which is able to withstand a compressive force - An intact buttress of the opposite cortex

8. Classification Static TB Dynamic TB

9. Indications for TB fixation Fracture in these regions Olecranon Transverse Patella Greater trochanter of femur Greater tuberosity of humerus Medial malleous Lateral end of clavicle Unusual site - Diaphysis of metacarpal and metatarsal - Arthrodesis of the thumb - Arthrodesis of the wrist

10. Contraindications Comminution at compression site Sepsis Osteoporotic bone

11. Preoperative principles

12. Resuscitation ATLS protocol

13. Establish indications History Examination Investigation Plain radiograph AP, Lat & special views CT-scan MRI Lab investigation

14. Preoperative planning Templating Surgical tactics

15. Obtained informed consent Blood grouping and cross matching

16. Intra-operative Principle

17. THE AO PRINCIPLES 1- Fracture REDUCTION - To restore anatomical relationships 2- Fracture FIXATION - Providing absolute stability 3- Preservation of BLOOD SUPPLY to soft tissues and bone

18. Prerequisite for Tension Band include; The implant must be able to withstand the tensile forces Bone which is able to withstand a compressive force - An intact buttress of the opposite cortex

19. Operative technique Radiolucent operating table Anaesthesia Intra-operative Antibiotics Positioning Tourniquet application

20. C-arm Instrument / implants Exposure / Haemostasis

21. Reduction technique Anatomical reduction required Reduction manuevers Use of hook reduction clamp

22. Inside – out technique Ensure no articular step

23. Fracture Fixation Outside- in or Inside-out technique Tension band device must be on the tension site (convex site) Wires should purchase the far cortex Two parallel wires are used

24. Cancellous screw can be applied to anchor cerclage wire 2.5mm drill is used to drill hole on bone for cerclage wire application Cerclage wire should tighten at two sides simultaneously

25. Tension band in other site Long bone Apply for simple fractures Apply plate on tension site No comminution on compression site Pre-bend plate Use compression plate ACDFI External fixation

26. Post operative principles Antibiotics Analgesia Limb elevation No additional support required

27. Early and safe MOBILIZATION of the TB part and the patient as a whole

28. Patella Isometric quadriceps exercises at once Partial weight bearing on fully extended leg: 30 kg week 0–6 - Full weight bearing: week 6–8 Olecranon Active-assisted mobilization start when pain subsides Partial functional use: week 4–8 Full functional use: week 8–12

29. Wound care Implant removal

30. Complications Wound infection Wire loosening or breakage K- wire backing Pressure necrosis Non-union

31. West African perspective Late presentation Lack of C-arm Lack of appropriate instrumentation and implant

32. Conclusions Tension band is an important concept of internal fixation, abiding strict principles is paramount for successful outcome

33. References Pauwels F. Biomechanics Of The Locomotor Apparatus. 1st Ed. Berlin Heidelberg New York: Springer- verlag 1980 Court-Brown CM, Heckman JD,McQueen MM, Ricci WM, Tornetta P. Rookwood and Green’s fracture in adult eight edition. Wolter cluwer 2015. p223-225 Clifford R. Olecranon fracture. Wheeless text book of orthopaedics Reudi TP, Buckly RE, Morgan GC, AO principles of fracture management. Thieme 2007. P165-187

34. Reudi TP, Buckly RE, Morgan GC, Tension Band principles . AO foundation publisher 2010 Rex C. K-wiring principles and techniques. Theime 2014. p 134-136 Smith TF. Tension band principles in foot and ancle surgery. Guide 2006. p 194-199 Sigh AP. Tension band principles and their application. Bone and spine.com

35. Deepak KR. Tension band wiring. AO education indian pre-basic course 2014. ppt Abubakar K. Principles of internal fixation. WACS. Ppt Nordin K. How to do tension band wiring. Ppt

36. THANK YOU