2. Aftercare following tension band wiring and ESIN
Immediate postoperative care
Whilst the child remains in bed, the elbow and forearm should be elevated on pillows to reduce swelling and pain.
Cast or splint immobilization
Fixation of olecranon fractures with tension band wiring is intrinsically stable and supplementary casting or splinting is therefore not required.
Ibuprofen and paracetamol should be administered regularly during the first 24-48 hours after surgery, with opiate analgesia for breakthrough pain.
Opiates should not be necessary after 48 hours and regular ibuprofen and paracetamol should be sufficient until 4-5 after injury or surgery.
The child should be examined if the level of pain is increasing or prolonged analgesia is needed.
The child should be examined regularly, to ensure finger range of motion is comfortable and adequate.
Neurological and vascular examination should also be performed.
Compartment syndrome should be considered in the presence of increasing pain, especially pain on passive stretching of muscles, decreasing range of active finger motion or deteriorating neurovascular signs, which is a late phenomenon.
Tension band wire removal is delayed until function has fully recovered and can be performed as a day case, under general anesthesia.
Usually the incision is smaller than for open reduction if the twisted wire ends lay close to the olecranon tip. Sometimes for cosmetic reasons, it is best to resect the whole scar and use cosmetic wound closure.
Make a small incision over the olecranon tip extract the two K-wires with pliers.
Unwind or cut the twisted wire and pull it out of the bony track.
Close the wound in layers.
Nail removal is delayed until the fracture has modelled completely and can be performed as a day case, under general anesthesia.
The nail end may slip under tendons and nerves. This may irritate the soft tissues and make it difficult to palpate the nail tip.
Exposure of the nail end should be performed under direct vision with small retractors.
In most cases, a small bursa forms over the nail tip. Once this bursa is opened, the end of the nail can be seen.
The nail can be removed with the extraction pliers, or a similar clamp. A strong needle holder is also useful.