Tension band systems and methods

A bone fixation assembly may include an elongate fixation member and a flexible tensioning element. The elongate fixation member may include a central longitudinal axis, a distal portion couplable to a first bone fragment of a bone, and a proximal portion couplable to a second bone fragment of the bone to provide fixation of the second bone fragment relative to the first bone fragment. The flexible tensioning element may be couplable to the proximal and distal portions of the elongate fixation member to secure the elongate fixation member to the bone. The flexible tensioning element may be configured to span a bone fracture intermediate the first bone fragment and the second bone fragment to preload the bone fracture in compression to resist tensile force imparted across the bone fracture, thereby maintaining fixation of the first bone fragment relative to the second bone fragment.