University Hospital Geneva, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
Arch Orthop Trauma Surg. 2011 Jan;131(1):131-8. doi: 10.1007/s00402-010-1156-6. Epub 2010 Aug 3.
The gold standard for treating transverse olecranon fractures is tension band fixation. A problem with this technique is migration of the K-wires leading to premature hardware removal. The aim of this study is to compare stability provided by two new techniques designed to eliminate the problem with backing out of K-wires, with that of the recommended tension band technique, performed with a biomechanical in vitro investigation. Our hypothesis was that the two new techniques would provide at least equal stability as the traditional tension band fixation.
Transverse olecranon osteotomies were created in human cadaveric elbows to simulate a type 21-B1.1 fracture. Three groups of 8 specimens were instrumented with: (1) recommended AO tension band technique; (2) modified K-wires with eyelets and tension band; (3) staples across the fracture with tension band. Each elbow was tested in a 90° flexed position. The triceps tendon was sinusoidally loaded by applying two load steps at 500 and 700 N for 4000 cycles each. Relative movements between the fragments were determined.
At the end of the first and second load step the displacement of the osteotomy at the posterior ulnar side was significantly less for the staples across the fracture with tension band as compared to both other groups. There were no significant differences between groups 1 and 2.
Since clinical results depend partly on stable fixation, it is concluded that using staples in the clinical situation might provide better results than the currently recommended tension band technique.
治疗横断尺骨鹰嘴骨折的金标准是张力带固定。该技术存在一个问题，即克氏针迁移会导致过早去除内固定物。本研究旨在比较两种新的技术提供的稳定性，这两种新技术旨在消除克氏针退出的问题，通过生物力学体外研究来评估其与推荐的张力带技术的稳定性。我们的假设是，这两种新技术至少能提供与传统张力带固定相同的稳定性。
在人体尸体肘部创建横断尺骨鹰嘴骨折来模拟 21-B1.1 型骨折。每组 8 个标本分别采用以下三种方法进行固定：（1）推荐的 AO 张力带技术；（2）带有环眼的改良克氏针和张力带；（3）横跨骨折的钢钉加张力带。每个肘部在 90°弯曲位置进行测试。通过施加两个 500N 和 700N 的负荷步骤，每个负荷步骤正弦加载 4000 次，测试肱三头肌肌腱。确定骨折块之间的相对运动。
在第一和第二负荷步骤结束时，与另外两组相比，横跨骨折的钢钉加张力带组的后尺骨侧骨切开处的位移明显更小。组 1 和组 2 之间无显著差异。
由于临床结果部分取决于稳定的固定，因此可以得出结论，在临床情况下使用钢钉可能比目前推荐的张力带技术提供更好的结果。
