Biomechanical comparison of tension band suture fixation and tension band wiring in olecranon fractures |
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| Affiliation: | 1. Department of orthopedic surgery, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark;2. Department of health technology, Technical University of Denmark (DTU), Copenhagen, Denmark;3. Department of orthopedic surgery, Copenhagen University Hospital, Rigshospitalet, Denmark;4. Department of orthopedic surgery, Zealand University Hospital, Køge, Denmark;3. Department of Orthopaedic Surgery, Atrium Health Navicent, Macon, Georgia;4. OrthoCarolina Research Institute Charlotte, NC;5. Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina.;6. Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA.;1. Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, North Carolina;2. Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Annandale, VA, USA;1. Royal Sussex County Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, United Kingdom;2. Department of Trauma and Orthopaedics, St Georges University Hospitals NHS Foundation Trust, Blackshaw Road, London, United Kingdom;3. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States;1. Spine Clinic & Traumatology, Private Hospital Bethanien, Swiss Medical Network, Zurich, Switzerland;2. Department of Traumatology, University Hospital Zurich, Switzerland;3. Department of Orthopedics & Traumatology, Landeskrankenhaus Bludenz/Feldkirch, Austria;1. Wright State University Department of Orthopaedic Surgery, 30 E. Apple St., Ste 2200, Dayton, Ohio 45409 United States of America;2. Wright State University Department of Infectious Disease, 30 E. Apple St., Ste 6258, Dayton, Ohio 45409 United States of America |
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| Abstract: | PurposeTraditional tension band wire fixation (TBWF) of olecranon fractures is associated with high revision rates due to implant-related complications. The purpose of the study was to compare the strength of fixation in olecranon fractures between TBWF and an all-suture based technique.MethodsA transverse fracture was created in 20 paired fresh-frozen human cadaveric elbows. Fractures were randomly (alternating right-left) assigned for fixation with either tension band suture fixation (TBSF) or TBWF. The elbow was fixed in 90° of flexion and underwent cycling loading by pulling the triceps tendon to 300 N for 200 cycles. Fracture displacement was optically recorded using digital image correlation (DIC). Finally, load-to-failure was assessed by a monotonic pull to 1000 N and failure mechanism was recorded.ResultsTwo specimens in the TBSF group were excluded from the cycling loading analysis due to technical difficulties with the DIC. After cyclic loading, median (min-max) fracture displacement was 0.28 mm (0.10–0.44) in the TBSF group and 0.18 mm (0.00–1.48) in the TBWF group (p = 0.315). No difference was found between the two groups in the repeated measures analysis of variance (p = 0.329). In the load-to-failure test, 6/10 specimens failed in the TBSF group (median load-to-failure 791 N) vs. 8/10 in the TBWF group (median load-to-failure 747 N). The TBSF constructs failed due to fracture of the dorsal cortex, suture breakage or triceps failure. The TBWF constructs failed due to breakage of the wire.ConclusionThere was no difference in fixation strength between the TBWF and TBSF constructs. Our findings suggest TBSF to be a feasible alternative to TBWF and we hypothesize that a non-metallic implant may have fewer implant-related complications.Level of evidenceBasic science study |
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