Abstract
BackgroundDisplaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically. The most common method is a tension band wiring (TBW) technique. Some surgeons concurrently employ an augmented circumferential cerclage wiring (ACCW) technique to help fracture stabilization and aid in fracture healing; however, its role and effect on the treatment outcomes is unclear.MethodsWe performed a STROBE-compliant retrospective observational cohort study on all cases of acute closed patella fracture that were treated at our institution between 2006 and 2012. Of 185 episodes, 72 (38.9%) were eligible for this study according to our inclusion/exclusion criteria. We classified these subjects with AO/OTA type 34-C1.1 or 34-C2 lesions into two groups for analyses: fractures treated with modified TBW and ACCW (group 1, n = 27) and those treated with modified TBW alone (group 2, n = 45). Plain radiographs were used to evaluate radiographic outcomes and the effect of potential risk factors on fixation failure was analyzed by subgroup comparisons.ResultsOur results revealed that there were no significant differences in the rates of fixation failure (P = 0.620), nonunion (P = 0.620), and revision surgery (P = 0.620) between the groups. Although not statistically significant, there was a trend towards a positive risk association between fixation failure and age distribution > 60 years (10.0% vs. 0.0%, P = 0.124; OR = 8.0, P = 0.168) and > 70 years (9.4% vs. 2.5%, P = 0.321; OR = 4.0, P = 0.237) and the superficial level of the K-wires (12.0% vs. 1.5%, P = 0.117; OR = 6.3, P = 0.121). Regarding those modified TBW patients concurrently treated with an ACCW, the potential risk association between fixation failure and the superficial level of the K-wire was prone to increase further (28.6% vs. 0.0%, P = 0.060; OR = 18.6, P = 0.071).ConclusionsConcurrent application of an ACCW might be needless and not efficacious to help fracture stabilization and healing in patients having been treated with modified TBW for displaced transverse fractures of the body of the patella. Adherence to correct surgical technique such as putting the K-wires at the proper level and securing control of the both ends of the K-wires may be more important and help in improving outcomes.
Highlights
Displaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically
To clarify the role of an augmented circumferential cerclage wiring (ACCW) on treatment outcomes of displaced transverse patella fracture, we classified the enrolled subjects into two groups for further analyses: fractures treated with modified tension band wiring (TBW) and ACCW and those with modified TBW alone
According to the inclusion/exclusion criteria, 72 (38.9%) of 185 episodes were eligible for this study and divided into two groups, including the group of fractures treated with modified TBW and ACCW and the group of those treated with modified TBW alone
Summary
Displaced transverse fractures of the body of the patella are usually associated with disruption of extensor mechanism and should be fixed surgically. Despite the potential occurrence of subjective complaints due to hardware irritation, TBW remains the gold standard for the treatment of displaced transverse fractures of the patella body [2, 3, 7, 8, 14,15,16,17]. A modified TBW technique involving bending both ends of the K-wires is used regularly Using this modified technique, Wu et al had reported an excellent treatment result with smooth fracture union, good recovery of joint motion, and few complaints of hardware irritation (3%) [15]
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