A comparative study of tension band wiring and reconstruction ...

Khanna et al
Severely comminuted fractures were given preference for
internal fixation with plate. Cases were classified as per Horne
and Tanzer’s Classification 6 (Table-1)
Type-1
Type-2
Type-3
Table 1
Showing the classification of Olecranon
Transverse intra-articular fractures on the proximal third
of the articular surface of the olecranon fossa or oblique
extra-articular fracture of the olecranon
Oblique or transverse fractures on the middle third of the
articular surface of the olecranon fossa.
Oblique or transverse fractures on the middle thirdof the
articular surface of the olecranon fossa.
Transverse or oblique fractures on the distal third ofthe
olecranon fossa.
3 rd generation cephalosporins plus aminoglycosides were given
for 72 hours.X-rays were taken on 1 st post-operative dayto
confirm the fixation and reduction. Wound site was checked
on 3 rd post-op day. Stitches were removed on 12th post-op
day.
The patients were examined on 3rd, 6th, 9th, 12th week
and at six weekly intervals after that. On every visit patients
were examined clinically and X-rays of the elbow taken in
anteroposterior and lateral view. Movements of elbow were
recorded. During the period of follow up, only active exercises
in physiotherapy centre or at home were advocated.
Every patient of each group then is graded during his
follow-up for clinical and radiological results as per criteria laid
by Rogers et al 8 . (Table-2)
Surgical steps:
Exposure: General Anesthesia or brachial block was preferred
and tourniquet was used in all cases. Posterior midline incision,
extending 2.5 cm proximal and 10 cm distal to the olecranon
was usedfor both groups and fracture site was exposed 7 .
ORIF with TBW: A hole was drilled transversely in the ulna
about 5-7 cm distal to fracture site. A Stainless steel wire No.20
was passed through this hole. Two parallel 2.00 mm K-wires
were drilled from the tip of the olecranon through the proximal
fragment in slight oblique anterior direction to engage the
anterior cortex of the distal fragment of ulna. The loop of wire
was crossed over the posterior surface of the olecranon in
figure of eight fashion and passed around the protruded K-
wires under the triceps tendon. The wire was tightened and
secured with a twist. Range of movements checked. K-wires
were cut and bended end was rotated posteriorly and impacted
in the olecranon under the triceps. Wound was stitched in
layers and was sealed and compression bandage applied.
ORIF with 3.5 mm Reconstruction plate: After reduction
of fragments, the fracture was temporarily fixed and aligned
with 2.00 mm K-wire passed from the tip into the medullary
canal of distal ulna. After necessary contouring of the plate, it
was applied subperiosteally on the posterior or posteromedial
surface of ulna, using 3.5mm cortical and 4.0mm cancellous
screws. K-wire was not removed in some cases so as to maintain
the fixation and alignment. Wound was closed in layers and
dressing was applied.
POSTOPERATIVE MANAGEMENT & FOLLOW UP
The operated limb was kept elevated for 48 hours. Intravenous
RESULTS
Table 2
SHOWING BASIS OF GRADING
Grade Loss of Loss of Union
movement supination and
at elbow pronation
Excellent