Medial malleolus fractures: A biomechanical comparison of tension band wiring fixation methods

Abstract

Background: This study compared the biomechanical properties of three different fixation methods of tension band wirings, used in the treatment of medial malleolus fractures. The first method used an innovative “handmade bent pin” for cerclage fixation. The second method used a U-shaped K-wire to attach the cerclage to the medial tibial cortex. These two novel fixation techniques were compared with the traditional tension band wiring technique, which is fixated to the bone by a screw. Hypothesis: Novel fixation techniques of tension band wiring provide stable fixation. Material and Methods: In this study 27 artificial bone models, which medial malleolus fractures were simulated on, were used. Using an electromechanical test device, the force required to pull out each implant was assessed and compared. Results: This study found that; while handmade bent pinning resulted averagely 840.25 N (range: 647–1066, ± 118.72) and U-shaped K-wire fixation was 381.71 N (range: 176–651 ± 150.2) pull out strength, traditional tension band wiring indicated 871.33 N (range: 549–1008, ± 137.74) pull out strength. Discussion: Handmade bent pinning method provides similar results with traditional tension band wiring. Therefore, in suitable cases, it may be an acceptable alternative to traditional tension band wiring techniques when treating malleolar fractures. Although the outcomes of U-shaped K wire fixation indicated lower than other two groups, the outcomes were comparable with the literature. So, while performing tension band wiring, both handmade fixation systems may be used in certain cases. For orthopaedic surgeons, it is better to know and think about these alternative handmade pinning systems created from simple K-wires during the surgery if needed. Level of evidence: IV, Biomechanical trial. © 2018 Elsevier Masson SAS