Abstract
Aims: To evaluate the effectiveness and safety of anterior tension band wiring technique using two cannulated cancellous screws in patients with transverse (AO34-C1) or transverse with mildly comminuted (AO34-C2) patellar fractures.Materials and Methods: This is a prospective study of 25 patients with transverse fracture or transverse fracture with mildly comminuted patella fractures. All the patients were treated with open reduction and internal fixation using two parallel cannulated screws and 18G stainless steel wire as per the tension band principle.Results: There were eighteen males (72%) and seven females (28%). The age group ranged from 24 to 58 years, with mean age of 38 years. The most common mode of injury was fall (72%) followed by road traffic accident (20%) and violent quadriceps contraction (8%). Transverse fracture was present in 60% and transverse fracture with mild comminution in 40% of patients. Mean time to achieve union was 10.7 weeks (range 8-12 weeks). Mean ROM at three months was 113.8 degree (90-130) and at final follow up this improved to 125.4 degrees (range 100-140). There was one case of knee stiffness and no case of implant failure was observed. Patients were evaluated using Bostman scoring, the mean score at three months being 26.04 which improved to 27.36 at the end of final follow up at one year.Conclusion: Cannulated cancellous screws with anterior tension band wiring is a safe, reliable and reproducible method in management of transverse patellar fractures, with less chances of implant failure and soft tissue irritation.
Highlights
The patella plays an important role in knee joint motion.Patellar fractures are mostly seen in the age group of 20-50 years, comprising about 1% of all skeletal injuries 1, 2
The surgical management of patellar fractures has evolved over the years from simple cerclage wiring to tension band wiring (TBW) 4 which was further modified to increase its strength
Cancellous screws have been used in the management of transverse patellar fractures, with high failure rates compared to modified tension band wiring
Summary
The patella plays an important role in knee joint motion.Patellar fractures are mostly seen in the age group of 20-50 years, comprising about 1% of all skeletal injuries 1, 2. To preserve the range of knee motion adequate management followed by aggressive post-operative rehabilitation is mandatory. The displaced patellar fractures are usually managed surgically to minimize the risk of developing post-traumatic arthritis 3, necessitating open reduction. The surgical management of patellar fractures has evolved over the years from simple cerclage wiring to tension band wiring (TBW) 4 which was further modified to increase its strength. Cancellous screws have been used in the management of transverse patellar fractures, with high failure rates compared to modified tension band wiring. The evolution in patellar fracture management has been necessitated by the need for stable fixation to allow early mobilization and aggressive rehabilitation to preserve the range of knee motion in the young physically active age group
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