Olecranon fracture: Tension Band Wiring

The 2 X-rays in the upper row were performed before the surgery and the lower 2 X-rays were performed after the surgery. It shows transverse displaced fracture of the olecranon process of the left upper limb. The fracture was managed with Open Reduction and Internal Fixation (ORIF) using the teachnique of Tension Band Wiring (TBW).

Distraction or tension interferes with fracture healing. Therefore, tension forces on a bone must be neutralized or, more ideally, converted into compression forces to promote fracture healing. This is especially important in articular fractures, where stability is essential for early motion and a good functional outcome. In fractures where muscle pull tends to distract the fragments, such as fractures of the patella or the olecranon, the application of a tension band will neutralize these forces and even convert them into compression when the  joint is flexed.

As shown in the X-ray above, a figure of "8" wire loop lies on the posterior surface of the olecranon and acts as a tension band when tightened. Approximately, 40mm below the fracture line and 5mm from the posterior cortex, a hole is drilled on the ulna. 2 K-wires are inserted almost parallely through the head of olecranon, directing towards the anteior cortex using drill guide. Long segment of the stainless steel wire is passed through the drilled holes in a figure "8" configuration beneath the triceps tendon around the protruding ends of the K-wires.
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