Treatment of comminuted patellar fractures by modified titanium tension band and cerclage

Abstract

Objective To investigate the postoperative recovery of knee function after comminuted fractures of patella were treated by modified titanium tension band and cerclage. Methods A retrospective cohort study was conducted of 36 comminuted patella fractures that had been treated from January 2012 to May 2014. They were 20 males and 16 females, with an average age of 48.7 years (from 18 to 75 years). Laterality: 15 left sides and 21 right ones. According to AO classification, 11 cases belonged to type 34-C2 and 25 to type 34-C3. There were two groups based on the fixation methods. Modified titanium tension band and cerclage was applied in 16 cases (7 males and 9 females). As a control group, conventional titanium tension band and cerclage was used in 20 cases (13 males and 7 females). The 2 groups were compared in terms of maximum active flexions of the knee at 1st, 2nd, 4th, 12th and 48th weeks postoperation. Bostman scores of the knee were also compared at 4th, 8th and 12th weeks postoperation between the 2 groups. Results The 36 patients obtained an average follow-up of 12.3 months (from 12 to 14 months) after discharge. No postoperative complications like wound infection or nonunion occurred in these patients. The maximum active flexions of the knee at 1st, 2nd, 4th, 12th and 48th weeks postoperation in the modification group (73.6°±4.2°, 87.8°±4.2°, 115.4°±4.7°, 128.6°±3.5° and 136.4°±2.5°) were significantly wider than in the control group (65.5°±4.1°, 79.4°±4.0°, 99.9°±5.0°, 119.2°±5.4° and 129.8°±4.4°) (P< 0.05). The Bostman scores at 4th, 8th and 12th weeks postoperation in the modification group (25.4±1.0, 27.2±1.1 and 28.1±0.7) were also significantly higher than in the control group (23.5±1.2, 25.8±0.9 and 27.7±0.7) (P< 0.05). Conclusion For the treatment of comminuted patellar fractures, modified titanium tension band and cerclage can lead to earlier and better recovery of the knee function than conventional tension band and cerclage. Key words: Patella; Fractures, bone; Fracture fixation, internal; Tension band