Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures: A strobe-compliant retrospective observational study.

Abstract

It was a retrospective case–control study. The aim of this study was to explore the clinical efficacy and complication of treatment using a modified Kirschner wire tension band (MKTB) or a cannulated screw tension band (CSTB) in transverse patellar fractures.In total, 55 patients with transverse patellar fractures were retrospectively reviewed and divided into 2 groups according to the surgical technique: 29 patients were in the MKTB group and 26 patients in the CSTB group. Bǒstman's clinical grading scale, including range of movement (ROM), pain, ability to work, atrophy of quadriceps femoris, assistance in walking, effusion, giving way, and stair-climbing, was used to evaluate the clinical results. Complications including painful hardware, implant loosening or breakage, and bone nonunion were also assessed.Both groups were evaluated at the final follow-up before removing implant in the MKTB group. The Bǒstman's score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group (P < 0.05). Twelve patients in the MKTB group underwent implant removal, and the score of ROM, pain, and effusion were higher than before removing implant (P < 0.05), but there was no difference compared to the CSTB group (P > 0.05). Seventeen patients achieved excellent results, 9 had good results, and 3 reported fair results in the MKTB group; the CSTB group had excellent results in 22 patients and good results in 4 patients, showing a significant difference in the excellent rate between the 2 groups (P = 0.021). Total Bǒstman scores in the MKTB and CSTB groups (26.96 ± 4.47 and 29.42 ± 1.47, respectively) were significantly different (P = 0.01). Total scores in the MKTB group after removing implant were higher than those before removing implant (P = 0.001), and similar to those in the CSTB group (P = 0.224). Eleven patients in the MKTB group reported painful hardware, including 4 cases of implant loosening.CSTB achieves better clinical results than MKTB, meanwhile avoiding the problems of painful hardware and implant loosening. Functional limitation caused by hardware pain was commonly seen in the MKTB group, and removing implant after fracture healing improved knee function.