Prospective Comparative Study of Fixing Displaced Transverse Patellar Fracture by Tension Band Wiring Versus Cannulated Screws with Wiring

Abstract

BACKGROUND: Transverse fractures of the patella are important fractures with a wide variety of subtypes, the common incidence in the age group of 20–50 years. Surgical interference aims to achieve a perfect alignment of the joint surface, in addition to rigid fixation of the fracture for early re-habitation and early movement to retain the extensor mechanism of the knee joint. AIM: The aim of this study was to compare the radiological and functional outcomes of the displaced transverse patella fracture in adult patients treated by ORIF using tension band wiring versus cannulated screws with wiring. METHODS: A prospective analytic comparative study was conducted in Al-Kindy Teaching Hospital/Baghdad/Iraq for 18 months from April 1, 2019, to October 1, 2020. It included 32 patients with isolated displaced transverse patellar fracture AO type 34-C1. The patients have undergone operative fixation with two different surgical techniques divided randomly by choosing every other patient into two groups. Group A, the fracture was fixed by cannulated screws with wiring and Group B, the fracture was fixed by two K-wires and with tension band technique. Postoperatively, assessment of the knee function by Lysholm score, the visual analog scale for pain intensity, and active flexion range of movement were measured in degree as primary outcomes, while time to union in weeks assessed radiographically as secondary outcomes. RESULTS: The patients’ age was ranging from 26 to 49 years, with males predominant. Low-energy falls occupying a major part of the mechanism of injury in both groups. Lysholm score was significantly increased after 3, 6, and 12 months compared to that after 1 month in both groups with no statistical differences. The mean visual analog score significantly decreased in Group A after 1 month than that in Group B with no significant change in the other follow-up periods. There were no statistically significant differences in both groups regarding the range of knee movement and the radiographic assessment of fracture healing. CONCLUSION: Both techniques are good and effective with taking into consideration that open reduction and cannulated screws fixation with wiring technique is shown to be associated with lower post-operative pain and a lower frequency of complications mainly surgical site infection.