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

John Clyde, Victor Kosmopoulos, Brian Carpenter

Research output: Contribution to journalArticle

7 Scopus citations


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.

Original languageEnglish
Pages (from-to)192-194
Number of pages3
JournalJournal of Foot and Ankle Surgery
Issue number2
Publication statusPublished - 1 Mar 2013



  • Ankle
  • Construct failure
  • Kirschner wire
  • Stiffness
  • Surgery
  • Tibia
  • Wire suture

Cite this