Tension band principls
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Tension band principls
- 1. Discuss Tension Band principles By Dr Kabiru SALISU 11th Aug. 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
- 8. 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
- 11. 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
- 13. Contraindications • Comminution at compression site • Sepsis • Osteoporotic bone
- 16. Establish indications • History • Examination Investigation • Plain radiograph AP, Lat & special views • CT-scan • MRI • Lab investigation
- 17. • Preoperative planning - Templating - Surgical tactics
- 18. • Obtained informed consent • Blood grouping and cross matching
- 20. 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
- 21. 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
- 22. Operative technique • Radiolucent operating table • Anaesthesia • Intra-operative Antibiotics • Positioning • Tourniquet application
- 23. • C-arm • Instrument / implants • Exposure / Haemostasis
- 24. Reduction technique • Anatomical reduction required • Reduction manuevers • Use of hook reduction clamp
- 25. • Inside – out technique • Ensure no articular step
- 26. 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
- 27. • 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
- 29. 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
- 30. Post operative principles • Antibiotics • Analgesia • Limb elevation • No additional support required
- 31. • Early and safe MOBILIZATION of the TB part and the patient as a whole
- 32. 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
- 33. • Wound care • Implant removal
- 34. Complications - Wound infection - Wire loosening or breakage - K- wire backing - Pressure necrosis - Non-union
- 35. West African perspective • Late presentation • Lack of C-arm • Lack of appropriate instrumentation and implant
- 36. Conclusions • Tension band is an important concept of internal fixation, abiding strict principles is paramount for successful outcome
- 37. 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
- 38. • 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
- 39. • 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
- 40. THANKYOU
Hinweis der Redaktion
- Tension band wiring is a fixation technique which results in absolute stability. Interfragmentary compression and direct bone healing is obtained.
- He observed that a curved, tubular structure under axial load always has a compression side as well as a tension side
- The implant alone does not provide stability. In combination with antagonistic deforming muscles, it can help produce uniform compression at the fracture site. It guides the compression force. The parallel wires serve as rails along which the bone fragments slide.
- A tension band can produce compression statically or dynamically. 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. Conversely, if the compression increases with motion, such as in the patella with knee flexion, the tension band is called dynamic
- Implant selection and availability Ensure availability of instrumentation
- K-wire 2mm Circlage wire 1- 1.2mm Planning is an important surgical discipline that encourages the surgeon to focus on the fracture pattern, fi xation technique and surgical approach. The surgeon can mentally rehearse the operation: Problems can be anticipated and avoided and alternative plans can be developed in case of arising diffi culties
- 1. Supine position 2. If extremity tends to externally rotate, place a “bump” under the ipsilateral hip. 3. General, spinal, or epidural anesthesia a. Relaxes muscles to facilitate repair b. Permits tourniquet use 4. Intravenous antibiotics ) 12. Intraoperative fluoroscopy or X-ray
- 5. Standard instrument set 6. Standard small fragment set 7. Large tenaculum clamps 8. Tension band wire (18 gauge) 9. Cannulated screws (4.0 mm) 10. Kirschner wires (2.0 mm) 11. Nonabsorbable suture (#5 Universal vertical midline incision a. Allows adequate exposure b. Functional incision if future surgery is needed 2. Place a tourniquet as proximal as possible on the thigh. 3. Remember to perform a meticulous retinacular repair. 4. Remove loose, minor fracture fragments—not all of the bone fragments need to be preserved. Preservation of only the major fragments is necessary. 5. Inspect the articular surfaces of the patella and femur because their condition will have a significant effect on the clinical outcome. 6. If necessary, consider lateral release to improve patella tracking.
- The knee joint and fracture lines must be irrigated and cleared of blood clot and small debris to allow exact reconstruction. The larger fragments are reduced using a pointed reduction forceps. In A- or C-type fractures, reduction is easier in a fully extended position of the knee. Longitudinal B-type fractures are more easily reduced with the knee flexed. Anatomical reduction of the articular surface is monitored by palpating the joint from inside, as neither inspection nor the xray will reveal a minor step off. If an inside-out technique is planned, K-wires are inserted in an open manner before the reduction is done. The wires can also be used as joysticks to help in reducing the fragments. Reduction is held by one or two reduction forceps. An image intensifier should always be available so that the reduction can be checked in the AP and lateral planes. Using the outside-in technique, drill the first Kwire in an axial direction. T he second K-wire is then drilled parallel to the first, through the reduced fragments. It may be difficult to find the right direction and position for the wires. Two parallel K-wires should be inserted to give more stable fixation
- 1.6- 2mm k-wire
- To tighten the wires in this fashion, pull away from the patella as the wires are twisted. The wires should be twisted at least 5 times so as to prevent fixation failure. When stainless steel wires tighten they will loose the surface sheen and if tightened further the wire may break. Care should be taken finally to position the twisted wire into deeper soft-tissue muscle layers, if possible
- Olecranon Active-assisted mobilization starting at once. Partial functional use: week 4–8 Full functional use: week 6–12
- Patella