Tension Band Wiring of the Olecranon and Patella

Indications

Patellar Fractures, tension band wiring of a transverse patella fracture
Tension band wiring of a transverse patella fracture. Image by Hellerhoff, Wikimedia Commons, CC BY-SA 3.0.
  • Simple transverse olecranon fractures
  • Transverse patellar fractures
  • Avulsion fractures of the medial malleolus and greater tuberosity can use the same principle
  • Comminuted olecranon fractures need plating

Position

  • Olecranon, lateral decubitus or prone with the arm over a bolster
  • Patella, supine with a thigh tourniquet
  • Image intensifier available
  • Tourniquet for the arm when lateral

Operative Steps

  1. Reduce the fracture and hold with a pointed reduction clamp
  2. Two parallel K wires across the fracture
  3. Olecranon wires can engage the anterior ulnar cortex, avoiding overpenetration into the forearm
  4. Figure of eight wire passed deep to the K wire ends and tensioned on both sides
  5. Bend and bury K wire ends
  6. Converts tensile force into compression at the articular surface during flexion
  7. Pass the wire deep to the triceps insertion close to bone
  8. Use a drill hole in the ulna 3 to 4 cm distal to the fracture for the distal limb of the wire
  9. Twist both sides of the figure of eight evenly to balance compression

Postoperative Care

  • Early active motion
  • Patella, protect extension until healing
  • Radiographs at 2 and 6 weeks
  • Avoid resisted extension until union

Complications

  • Symptomatic hardware is common and often needs removal
  • Wire migration
  • Not suitable for comminuted or oblique fractures
  • Loss of fixation and nonunion
  • Infection over subcutaneous hardware
  • Ulnar nerve irritation

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.