Tension Band Wiring

Tension Band Wiring - Wire Power!

• Principle: Converts tensile forces (muscle pull) into dynamic interfragmentary compression during joint motion. (Pauwels' Principle).
• Mechanism: Wire placed on tension (convex) side of an eccentrically loaded bone. Limb flexion tightens wire, compressing fracture.
• Indications (Articular/Avulsion Fractures):
  • Patella (transverse)
  • Olecranon (transverse, non-comminuted)
  • Medial malleolus (avulsion)
  • Greater trochanter (avulsion)
  • Acromion (displaced)
• Construct:
  • K-wires (typically 2, parallel): Provide anti-rotation, serve as scaffold.
  • Figure-of-8 wire loop: Creates dynamic compression.
• 📌 Mnemonic (Sites): "POTMA" (Patella, Olecranon, Trochanter, Malleolus, Acromion).

⭐ For TBW success, the cortex opposite the wire (compression side) must be intact or reconstructable to provide a buttress.

Tension Band Wiring - When Wires Work

• Principle: Converts tensile forces into dynamic compressive forces across a fracture, promoting stability. (Pauwels' principle).
• Indications:
  • Avulsion fractures: Patella, olecranon, medial malleolus, greater trochanter.
  • Transverse fractures: Patella, olecranon.
  • Articular fractures needing early motion.
• Technique:
  • Two K-wires for alignment & rotational stability.
  • Figure-of-eight wire loop on tension surface.
  • Flexion ↑ compression at fracture.

  ⭐ For successful tension band wiring, an intact or reconstructable buttress on the compression side of the bone is essential to prevent fracture collapse.

• Advantages: Simple, minimal hardware, allows early Range of Motion (ROM).
• Contraindications: Severe comminution (especially on compression side), fractures not primarily under tensile stress.

Tension Band Wiring - Step-by-Step Wiring

• 1. Fracture Reduction:
  • Achieve anatomical alignment.
  • Provisional fixation if needed (e.g., using clamps).
• 2. K-wire Insertion:
  • Insert two parallel K-wires (e.g., 1.6mm or 2.0mm).
  • Cross fracture site, engage far cortex.
  • Avoid articular surface penetration.
• 3. Figure-of-8 Wire Application:
  • Use 18-gauge or 20-gauge (approx. 1.0mm or 0.8mm) stainless steel wire.
  • Pass wire under K-wire ends or through a transverse drill hole on the tension side of the bone.
  • Create a figure-of-8 loop.
• 4. Wire Tensioning:
  • Twist wire ends evenly using a wire tightener.
  • Achieve compression at the fracture site.
  • Avoid over-tightening (risk of wire breakage or bone cut-out).
• 5. K-wire Management:
  • Bend K-wire ends over the wire loop, or cut short and impact.
  • Ensure ends are buried to prevent soft tissue irritation.

⭐ The figure-of-8 wire converts distracting tensile forces into dynamic compressive forces across the fracture line, especially during joint flexion when the wired surface is convex (tension side).

Tension Band Wiring - Wire Wisely

• Principle: Converts tensile forces into compressive forces across a fracture site, promoting stability and healing. Dynamic compression.
• Indications:
  • Transverse fractures: Patella, olecranon, medial malleolus.
  • Avulsion fractures: Greater trochanter, tibial tuberosity.
• Technique:
  • Two parallel K-wires across fracture.
  • Figure-of-8 wire loop (typically 1.25 mm or 1.6 mm stainless steel wire).
  • Tightened on tension side.
• Mechanism: During joint flexion, muscle pull on wire creates compression at articular surface.
• Advantages: Stable fixation, allows early joint motion.
• Complications: K-wire migration, skin irritation, hardware failure.

⭐ Tension band wiring is most effective when the fracture is on the tension side of an eccentrically loaded bone and the wire is placed on this tension surface.

High‑Yield Points - ⚡ Biggest Takeaways

• Tension Band Wiring (TBW) converts tensile forces into compressive forces across a fracture site.
• Requires an intact opposite cortex (buttress) to function effectively.
• Primarily indicated for avulsion fractures and transverse fractures of the patella, olecranon, and medial malleolus.
• Typically involves two parallel K-wires and a figure-of-eight wire loop on the tension side.
• Achieves dynamic compression as the joint moves, promoting fracture healing.
• Contraindicated in comminuted fractures or if the opposite cortex is deficient.
• The wire loop must be placed on the tension surface of the bone for optimal results.