Fracture patella: Fixation with cancellous screws and anterior cerclage wiring

Abstract

Patella is the largest sesamoid bone. It is a triangular bone that lies within quadriceps tendon. Fractures of patella constitute approximately 1% of all skeletal injuries and occur in all age groups. There is always a need to salvage the fracture as it is an important functional structure in extensor mechanism of knee. Its report to evaluate the effectiveness and safety of anterior cerclage wire/tension band wiring technique using two or more cannulated cancellous screws in patients with transverse or transverse with comminuted patellar fractures. Material and Methods: This is a prospective study of 28 patients with transverse or transverse with comminuted fractures. All patients were treated with open reduction and internal fixation using multiple cancellous screws (more than two) and 18G stainless steel wire except two cases with TBW with k wire as per tension band principle. Result-There were 28 patients, 24(85.71%) males and 4(14.28%) females. The age group ranged from 22-60 years with mean age 38 years. The mode of injury was either direct or indirect trauma, fall (74%) followed by RTA (18%) and violent quadriceps contraction (8%). Transverse fractures were present in 60% patients and transverse fracture with comminution in 40% patients. Mean time to achieve union was 10.7 weeks (Range 8-12 weeks). Cases were followed up for 3 months, then at 6 months, thereafter 6 monthly and assessed for recovery of knee function. Study continued up to 12 months to 18 months. Mean ROM at the end of 3 months was 113.8° (90-130) and at final follow up this movement improved up to 125.4° (ROM 100-150). There was loss of reduction in one case, one case of infection and one case of nonunion. No case of implant failure was observed. The study was conducted in Department of Orthopaedics, Hi Tech Medical College, Rourkela and SB Medical College, Hazaribag. The results were graded according to the criteria given by Gaur et al. IJO May 1997. Conclusion: The criteria for surgery, open reduction and internal fixation with multiple cannulated cancellous screws with anterior cerclage was if ˃ 3mm displacement and ˃ 2mm articular step off was present. The screws provide rotation control of fragment and anchorage of cerclage wire. It provides additional compression across the fracture site. Open reduction and internal fixation with cannulated cancellous screws with anterior cerclage /TBW is a safe, reliable and reproducible method in the management of transverse or transverse with comminuted fractures, with less chances of implant failure and less soft tissue irritation.