Elbow Fractures: Tension Band Cerclage

Elbow Fractures: Tension Band Cerclage

This surgical video demonstrates the repair of an elbow fracture using a tension band cerclage. This procedure uses a flat, braided suture replacing metal wires in the traditional construct. These sutures help the bone heal by providing secure support while remaining flexible, thereby reducing the likelihood of feeling the implant under the skin.

Here, we see a left arm with the elbow straightened. The patient is lying face down on the operating table. Their shoulder is toward the right side of the screen, and their hand is toward the left side of the screen. The patient has a fracture at the olecranon of the ulna bone, a forearm bone that forms part of the elbow joint. The surgeon has already made a skin incision and opened the skin to identify and protect the ulnar nerve.

First, the surgeon uses a clamp to put the fracture segments back together. Then, to maintain this position, the surgeon drills 2 wires into the bone. The wires are bent and cut to create loops for the suture to pass through later in the procedure. On the other side of the fracture, the surgeon drills into the bone to create a tunnel. A wire loop is passed into the tunnel. The tail of the suture is passed into the loop, which is pulled to pass the suture through the bone.

Through the loops of the wires that were previously made, the surgeon passes a needle with a loop. The suture tail is passed through the loop of the needle and pulled through the loops of the wires. Next, the suture tail is passed through the loop of the device that holds the suture, the loop is pulled back, and the suture tail passes through the device to create a knot. The knot is pulled off the device. The surgeon readjusts the sutures to tighten them close to the bone.

Next, the surgeon cuts the suture tail. The 2 suture strands are wrapped around a tensioning device. The surgeon twists the tensioning device to tighten the sutures to make the tension band cerclage. The surgeon ties knots to secure the position of the cerclage. The ends of the sutures will be cut off, the skin incision will be closed, and the procedure is complete.