A comparative study of tension band wiring and reconstruction ...
A comparative study of tension band wiring and reconstruction ... 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
A comparative study of tension band wiring and reconstruction plating in olecranon fractures Fig 1. Showing results of Group B Table 3 Showing Complications Complications Group A Group B No. of cases %age No. of cases %age Superficial infection 2 13.3 1 6.7 3 10.0 Deep infection 1 6.7 - - 1 3.4 Delayed union - - 1 6.7 1 3.4 Non union - - - - - - Symptomatic metal skin impingement 5 33.3 1 6.7 6 20.0 Implant loosening (plate loosening/ proximal migration) 2 13.3 - - 2 6.7 Implant exposure - - - - - - Implant failure - - - - - - Pb Journal of Orthopaedics Vol-XIII, No.1, 2012 59
A <strong>comparative</strong> <strong>study</strong> <strong>of</strong> <strong>tension</strong> <strong>b<strong>and</strong></strong> <strong>wiring</strong> <strong>and</strong><br />
<strong>reconstruction</strong> plating in olecranon fractures<br />
Fig 1. Showing results <strong>of</strong> Group B<br />
Table 3<br />
Showing Complications<br />
Complications Group A Group B<br />
No. <strong>of</strong> cases %age No. <strong>of</strong> cases %age<br />
Superficial infection 2 13.3 1 6.7 3 10.0<br />
Deep infection 1 6.7 - - 1 3.4<br />
Delayed union - - 1 6.7 1 3.4<br />
Non union - - - - - -<br />
Symptomatic metal skin impingement 5 33.3 1 6.7 6 20.0<br />
Implant loosening (plate loosening/ proximal migration) 2 13.3 - - 2 6.7<br />
Implant exposure - - - - - -<br />
Implant failure - - - - - -<br />
Pb Journal <strong>of</strong> Orthopaedics Vol-XIII, No.1, 2012<br />
59
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