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Tension Band Fixation: w/ Screws

- Discussion:
    - interfragmentary screw fixation can be easily and securely combined w/ the use of an anterior tension band which provides resistance to 
          fracture displacement from anterior distraction when knee is in extension as well as resistance to displacement as the knee moves into 
    - this method is most appropriate for simple, non-comminuted transverse frxs;
    - screw types:
          - 3.5-mm cortical screws are best suited for this;
          - technique uses 4.0 to 4.5-millimeter cannulated screws;
          - 4.0 or 4.5-mm screws to be the most appropriate;
    - provisional fixation can be achieved w/ cannulated-screw guide-wires or with reduction forceps;
    - screws are placed across the fracture in lag fashion, w/ threads engaging only the far side of the fracture;
    - screws are best left 4-5 mm short of measured length;
    - of tension-band wire is placed through one of the cannulated screws;
         - then placed over the anterior surface of the patella
         - then thru center of other cannulated screw
         - then back over anterior surface of patella, where it is twisted to other end of wire;
        - two twists in the wire can be used to tighten each limb of the tension band symmetrically;
     - cautions:
               - it is essential the screw threads cross the fracture site w/o protruding thru the far cortex;
               - in the case of a proximal fracture, the screws should be inserted from superior to inferior (instead of the usual inferior to superior)