Original Research| Volume 52, ISSUE 2, P192-194, March 2013

A Biomechanical Investigation of a Knotless Tension Band in Medial Malleolar Fracture Models in Composite Sawbones®

  • John Clyde
    Department of Orthopaedic Surgery, John Peter Smith Hospital, Tarrant County Hospital District, Fort Worth, TX
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  • Victor Kosmopoulos
    Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX
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  • Brian Carpenter
    Address correspondence to: Brian Carpenter, DPM, AACFAS, Associate Professor, University of North Texas Health Science Center, Department of Orthopaedic Surgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX 76104.
    Associate Professor, Department of Orthopaedic Surgery, John Peter Smith Hospital, Tarrant County Hospital District, Fort Worth, TX; and Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX
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Published:December 18, 2012DOI:


      The present study introduces a knotless tension band construct and compares its biomechanical behavior with that of a traditional stainless steel tension band construct. Fourth-generation composite tibial Sawbones® were used in the present study. Fracture models were created to mimic Orthopaedic Trauma Association type 44-B2.2 ankle fractures. A total of 20 specimens were randomized evenly into a stainless steel tension band group (control group); or a knotless tension band group. The fixation constructs were mechanically tested, and the stiffness and failure strengths were calculated. Two failure strengths were determined: the engineering-based failure strength, defined as the greatest tensile load tolerated by the construct; and the clinical failure strength, defined as the force required to displace the fracture by 2 mm. We used 2-tailed independent samples t tests to compare and identify significant differences. The knotless tension band construct was 7.7% stronger and 33.2% stiffer and required a 36.7% greater force to displace the fracture by 2 mm. Independent sample t tests confirmed that differences in mean stiffness (p = .003) and clinical failure strength (p = .003) were statistically significant. Although the mean engineering strength for the knotless group was greater than that for the stainless steel group, this difference was not statistically significant (p = .170). This knotless tension band construct could potentially offer both clinical and biomechanical advantages compared with the current stainless steel standard.

      Level of Clinical Evidence


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