Modified Tension Band Wiring in Adult Distal Humeral Fracture Types A2 and C1



1 Orthopedic Department of 5Azar Hospital, Golestan University of Medical Science, Gorgan, Iran

2 Shoulder & Elbow Department, IRCCS Humanitas Institute, Rozzano, Milan, Italy

3 Tehran University of Medical Science, Tehran, Iran


Background: Distal humeral fractures accounts for approximately 2% of all fractures and nearly one-third of humeral
fractures in adults. In this regard, Modified Tension Bind Wiring (MTBW) technique was used for the fixation of the distal
humeral fractures type A2 and C1 (AO) to evaluate the early movement and complications of the patients.
Methods: This study was conducted on 25 patients, who were subjected to open reduction and internal fixation using
MTBW techniques, to evaluate the incidence of complications.
Results: The mean age of the participants was 53.7 years. Out of 25 patients, 16 cases had C1 and 6 individuals
suffered from A2. The mean tourniquet time was 43 min. The mean union time was 12.24 weeks and the mean duration
of the follow-ups was 13.72 months. The mean values for the lack of extension, flexion, and range of motion were 18o,
124o, and 106o, respectively. Wound haematoma and dehiscence were observed in two cases, who were treated after
conservative treatment. During 15-90 days, there were no signs of neurapraxia injuries. The non-union of olecranon
osteotomy site was seen in one case, who was treated by the MTBW technique. Since the range of motion was less
than 100o in 4 patients, device removal was performed 6 months after the surgery when the range of motion was
increased by nearly 12o. Moreover, patients were diagnozed with no serious complications, such as the nonunion of
fracture site, malunions, and deep infection. The radiological examination of the patients revealed the success of their
Conclusion: Based on the obtained results, it can be concluded that MTBW is an effective technique in fracture
fixation, which allows gentle early motion. Moreover, this cost-effective technique decreased the surgery duration,
tourniquet time, and damage caused by soft tissue stripping.
Level of evidence: IV