title: Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection.
abstract: OBJECTIVE
  The tension band wiring (TBW) technique is a common treatment for the fixation of olecranon fractures with up to three fragments. The literature and surgeons describe TBW as an uncomplicated, always available and convenient operation producing excellent results. The purpose of this study was to determine whether TBW is more ambitious than believed or the procedure provides an increased level of tolerance concerning the surgical technique.
  
  
  METHODS
  This study reviewed 239 TBW cases in patients with olecranon fractures or osteotomies. We reviewed a total of 2,252 X-rays for ten operative imperfections: (1) nonparallel K-wires, (2) long K-wires, (3) K-wires extending radially outwards, (4) insufficient fixation of the proximal ends of the K-wires, (5) intramedullary K-wires, (6) perforation of the joint surface, (7) single wire knot, (8) jutting wire knot(s), (9) loose figure-of-eight configuration, and (10) incorrect repositioning.
  
  
  RESULTS
  On average, there were 4.24 imperfections per intervention in the cases reviewed. A total of 1,014 of 2,390 possible imperfections were detected. The most frequent imperfections were insufficient fixation of the proximal ends of the K-wires (91% of all cases), the use of a single wire knot (78%) and nonparallel K-wires (72%). Mayo IIa (n = 188) was the most common fracture type.
  
  
  CONCLUSIONS
  Our results and the number of complications described by the literature together support the conclusion that TBW is not as easy as surgeons and the literature suggest. Although bone healing and the functional results of TBW are excellent in most cases, the challenges associated with this operation are underestimated.
  
  
  METHODS
  IV, treatment study.
authors: Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Albertus Magnus University, Cologne, Germany, marco.schneider@orthopia.com.
authors: Marco M
authors: MM
authors: Schneider
authors: Tobias E
authors: TE
authors: Nowak
authors: Leonard
authors: L
authors: Bastian
authors: Jan C
authors: JC
authors: Katthagen
authors: Jörg
authors: J
authors: Isenberg
authors: Pol M
authors: PM
authors: Rommens
authors: Lars P
authors: LP
authors: Müller
authors: Klaus J
authors: KJ
authors: Burkhart
mesh_terms: D002983:Clinical Competence; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D056740:Olecranon Process / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D012189:Retrospective Studies