Modified Tension Band Wiring Research Articles

Evaluation of the functional result of early knee mobility in transverse patellar fractures treated with modified tension band wiring

Evaluation of the functional result of early knee mobility in transverse patellar fractures treated with modified tension band wiring

COMPARATIVE STUDY OF TENSION BAND WIRING, MODIFIED TENSION BAND WIRING AND FULLY THREADED CANNULATED CANCELLOUS SCREWS FOR FIXATION OF MEDIAL MALLEOLUS FRACTURES

Objective: To compare the three most commonly used fixation techniques: “Tension band wiring, modified tension band wiring, and fully threaded cannulated cancellous screws for fixation of medial malleolus fractures.” Methods: A prospective comparative cohort study was carried out at a tertiary care hospital in rural Maharashtra. Patients were allocated into three groups, with 33 patients in each group. The internal fixation was done by tension band wiring, modified tension band wiring, or fully threaded cannulated cancellous screws, depending on the group to which a patient belonged. Patients were assessed using the Baird and Jackson scoring system at each follow-up at immediate post-operative period, at 3, 6, 12, 24 weeks, and 1 year. For statistical purposes, p<0.05 was considered statistically significant. Results: There was no significant difference in the three groups as regards age, body mass index, and mean time from injury to management. The most common mode of injury was road traffic accidents (51.52%), followed by falls from height (27.27%) and sports-related injuries (21.21%). The mean duration of surgery was significantly longer in cases managed by tension band wiring as compared to the other two groups. Implant-related complications were significantly less in the threaded cannulated cancellous screw group as compared to the other two groups. Overall excellent to good outcomes were observed in 97% of cases of cannulated cancellous screws as well as in modified tension band wiring and 84.8% of cases of tension band wiring, respectively. Conclusion: Fully threaded cannulated cancellous screws or modified tension band wiring should be used for the management of medial malleolar fractures while considering the functional outcome and complications associated with each and patient-related factors.

Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis

BackgroundThe most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture.MethodsA finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis.ResultsCompared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group.ConclusionSCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions.

Inter-fragmentary compression using cannulated cancellous screws augmented with modified tension band wiring in transverse patella fractures

The classical Kirschner wires and tension band wiring technique, described by the AO foundation, has been the most widely used method for transverse patella fractures. In this study, we have adopted what we perceive to be an improved technique, the cannulated cancellous screws with modified tension band wiring. 20 patients with transverse patella fractures were included in our prospective single-blinded randomized control study with a duration of 3 years. All patients were operated on with modified tension band wiring with a 4 mm cannulated cancellous screw. Functional evaluation was made using the Tegner lysholm knee scoring scale. Roentgenograms were taken in AP and Lateral views to look for signs of radiological union and interfragmentary gap. The post-operative interfragmentary gap between fracture fragments with 65% of patients having a 0 mm gap, 25% of patients having a 1 mm gap, 5% of patients having a 2 mm gap, and 5% of patients having a 3 mm gap. The mean duration for the radiological union was 10 weeks. Mean Tegner lysholm score at 6 months was 88±4.7. We concluded that modified tension band wiring with cannulated cancellous screw is a safe, reliable, and better alternative method of fixation for transverse patella fractures with excellent union rate, range of motion, and functional outcome.

Figure of eight suturing technique with fiber wire for patella fracture: a novel approach

Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. Tension band wiring, inter-fragmentary screw fixation, and the combination of cerclage wiring and screw fixation are used for internal fixation of these fractures. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement. In this series, we present ten cases managed with open reduction and internal fixation with figure of eight suturing technique using fiber wire. This series included ten patients with fractured patella and managed with open reduction and internal fixation with Tension band wiring with fiber wire. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months. All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lysholm score and Bostman score were 85 and 27 respectively. Nine patients had excellent to good outcomes. One patient had poor outcome because of knee stiffness. Open reduction and internal fixation with figure of eight suturing technique using fiber wire are an efficient method for the management of severely comminuted and multi-fragmentary patella fractures with minimum complications.

Modified tension band wiring of transverse patella fractures through cannulated cancellous screws: An analysis of functional outcomes and complications

Introduction: The management of transverse patella fractures with modified tension band wiring using Kirschner wires, though routinely used is associated with complications such as implant loosening, wire migration, and infection. We hypothesized that using cannulated cancellous screws with tension band wiring through the screws will overcome these complications. Objective: The objective was to assess the functional and radiological outcomes following patellar fracture fixation with modified tension band wiring through cannulated cancellous screws. Materials and Methods: Twenty-four patients with transverse patella fractures fixed with modified tension band wiring through cannulated cancellous screws were included in this retrospective study. Surgical technique involved a vertical incision over the knee, reduction of the fracture initial fixation with Kirschner wires, replaced with cannulated cancellous screws. A stainless steel wire was passed through the lumen of the screws, and tension band was applied. Follow-up at 3, 6, and 12 months was done to assess the radiological union. Functional outcome was assessed with the Bostman scoring. Results: The study included 13 male and 11 female patients with an average age of 39.6 years, with 8 three-part and 16 two-part fractures. The average follow-up was 14 months, and the average time to union was 8.5 weeks. Twelve patients had an excellent, 11 patients a good, and one patient an unsatisfactory functional outcome as per the Bostman score. No infection or implant loosening was observed. Conclusion: The technique of patella fracture fixation with modified tension band through cannulated cancellous screws offers an enhanced stability, minimizing the complications such as implant migration, prominent implant, and refracture. As such, we recommend this technique in all transverse patella fractures.

Comparison of The Two Different Patella Fracture Fixation Technique: Finite Element Analysis

Introduction: Fractures of patella account for 1% of bone fractures and this type of injuries can lead to severe knee funciton restrictions due to its role in extansor mechanism. The most common type of fracture pattern is transverse or comminute. According to the guidelines, the most often used surgical techniques are modified tension band wiring and circumferential cercle wiring. However there is no clear information about the configuration of cerclage wiring in the tension band technique. For this purpose, a transverse fracture line was created in the patella finite element model and biomechanical comparison was made in both figure of eight and zero configurations
 Material and Method: A transverse fracture line was created in patella and the k-wires were directed proximally at 90 degrees in coronal plane, perpendicular to the fracture line. A cerclage wire was wound on each finite element model in figure of zero (reference 1 model) and figure of eight (reference 2 model) configurations. These models were compared with each other in finite element model, with the knee at a 45 degree flexion angle and applying 200 Nm, 400 Nm and 800 Nm of force.
 Results: When the opening amounts of reference 1 and 2 models were evaluated under 200 Nm, 400 Nm, and 800 Nm loads, it was found that there were 14%, 8%, 13% less openings in the reference 1 model, respectively. When the amount of pressure in the fracture line was evaluated under the same loads, the average pressure was 10%, 15% and 12% higher in the reference 1 model compared to the reference 2 model, respectively.
 Conclusion: When the determined parameters were evaluated, although the amount of opening at the fracture line was better in the reference 1 model, there was no significant difference between the parameters in both models. Both fixation types allow early motion in clinical applications and help the prevention of displacement of the fracture.

Understanding the Basic Principles and Biomechanics of Patellar Modified Tension Band Wiring Surgery: Are we on a Monotonous Path for Fixing Transverse Patellar Fractures?

Understanding the Basic Principles and Biomechanics of Patellar Modified Tension Band Wiring Surgery: Are we on a Monotonous Path for Fixing Transverse Patellar Fractures?

Early Complications of Modified Tension-Band Wiring (MTBW) in the Treatment of Close Patellar Fractures

Introduction: Patella fracture account for 1 Percent of all skeletal fracture, Patella fractures are problematic because the loss of the extensor mechanism of the knee, loss of articular congruity and stiffness of the knee joint. The surgical goals are anatomic reconstruction of the articular surface and stable fixation to allow early motion. Modified tension band wiring MTBW (MTBW) is the procedure of choice for patellar fracture these days because of the dramatic decrease in post-operative complications with this procedure.The complications noted in the early post-operative period are infection,loss of reduction, prominence of hardware, and knee stiffness. Objective: To determine the frequency of early post-operative complications following modified tension band wiring MTBW for closed patellar fractures. Methods: This study was conducted in the department of orthopedic surgery, Lady Reading Hospital, Peshawar from June 2010-september 2011. Through a descriptive cross sectional study, a total of hundred patients of closed patellar fractures were selected in a consecutive manner from the OPD and ER department. All patients were subjected to modified tension band wiring MTBW under G/A by an expert orthopedic surgeon and data was also collected at 1st week, 1st month, 3 months and 6 months regarding early post-operative complications like loss of reduction, infection, prominence of hardware and stiffness. Results: Total patients were hundred. There were 60 (60 Percent) males and 40 (40 Percent) were females. Mean age of the patients was 43.82 years + 14.3SD years (range 20-85 years). 74 (74 Percent) were presented with history of road traffic accident. Overall complication rate by the end of 6 months was a total of 25 Percent with of 21 Percent patients with infection, 11 Percent had developed stiffness, 6 Percent with hardware prominence and only 4 Percent with loss of reduction. Conclusion: The frequency of early post-operative complication following modified tension band wiring MTBW for closed patellar fractures was higher than previously reported and further research work should be carried out to identify the factors responsible for it. Keywords: Developed Stiffness, Closed Fracture Patella, Modified Tension Band Wiring MTBW, Early Post-Operative Complications, Hardware Prominence,

Does pin configuration matter in modified tension band wiring for transverse patellar fracture? A biomechanical study

BackgroundModified tension band wiring has been widely used for the treatment of transverse patellar fractures. The optimal position of a Kirschner wire (K-wire) in modified tension band wiring, however, has not yet been determined. The purpose of the present study was to evaluate biomechanically the effect of K-wire position in a modified tension band wiring technique. MethodsForty-two polyurethane foam patellae with a midway transverse fracture were assigned to six different fixation groups regarding different pin configurations in tension band wiring. The depth or sagittal position of the K-wire was divided into anterior and posterior. The coronal position of the K-wire was divided into central, medial and lateral. A specially designed set up simulated a knee with 60° flexion. All specimens were tested under axial traction. Loads at 2 mm and 4 mm fracture displacement and at the failure of the construct were recorded. ResultsAt 2 mm fracture displacement, anterolateral (AL) placement of K-wires revealed significantly less durability when compared with five other groups (P < 0.001). At 4 mm fracture displacement, the AL group also revealed inferior biomechanical strength when compared with other groups. Posteromedial (PM) K-wire placement group revealed more durability when compared with the posterolateral (PL) group (P < 0.05). At failure of the osteosynthesis, anteromedial (AM) and anterocentral (AC) groups revealed superior biomechanical strengths (P < 0.05). ConclusionsThe coronal and sagittal position of K-wire affects the biomechanical characteristics of modified tension band wiring. Anterolateral placement of K-wires revealed inferior strength to all other constructs in modified anterior tension band wiring.

Evaluation of Internal Fixation of Patellar Fractures Using Cannulated Screws with Tension Band versus Modified Tension Band Wiring

Evaluation of Internal Fixation of Patellar Fractures Using Cannulated Screws with Tension Band versus Modified Tension Band Wiring

Modified Tension band wiring vs Tension band with cannulated cancellous screws in treating transverse patellar fractures

Purpose: Despite being the most favoured modality of treatment in patellar fractures, modified tension band wiring (MTBW) technique has serious demerits with regards to clinical outcomes. Tension band with cannulated cancellous screws (TBCC) is a recent technique to overcome the demerits associated with former technique. This study was aimed to compare these two techniques, in terms of clinical outcomes, in treating patellar fractures. Methods: This hospital based prospective randomized study was conducted in a tertiary care hospital for 2 years. Thirty patients with Gustillo-Anderson grade 1 and 2 compound fractures were randomly divided into two treatment groups, viz MTBW and TBCC groups. After performing pre-operative investigations, patients were anesthetized, and knee was operated by the standard procedures. Post-surgery, radiographs were taken and range of motion, pain score (Visual Analogue Scale (VAS)), time taken for radiological union, clinical outcomes were recorded. Results: Mean age of the patients included in the MTBW and TBCC group were 53 years and 58.5 years, respectively. Between the groups, range of motion, IOWA score assessed at the end of 6 months, did not vary significantly (P&gt;0.05). Meanwhile, the difference noticed with average time taken for radiological union was also nonsignificant (MTBW =11 weeks. TBCC=10 weeks).

Management of Patella Fractures Non-amenable to Tension Band Wiring: Series of Nine Cases with Review of Literature.

Introduction:Patella fractures account for about 1% of all musculoskeletal injuries. Modified tension band wiring (TBW) is the most commonly used technique for the management of patella fractures. However, all patella fractures are not-amenable to TBW. In this series, we present nine cases managed with open reduction and internal fixation using non-absorbable braided polyester suture (Ethicon Ethibond Excel 5-0) with circumferential stainless-steel wiring.Case Series:This series included nine patients with fractured patella and managed with open reduction and internal fixation with non-absorbable sutures and circumferential wiring. Patient demographics, fracture type, time to union, functional outcome, and complications were recorded. Patients were followed up for minimum of 6 months (11.6 ± 3.7 months). All fractures went on to unite with average fracture healing time of 13.8 weeks. Mean Lyshom and Bostman score were 83 and 25.6, respectively. Seven patients had excellent to good outcome. One each had fair and poor outcomes. One patient developed superficial infection and knee stiffness.Conclusion:Open reduction and fixation with non-absorbable sutures augmented with circumferential wiring are an efficient method for the management of severely comminuted and multi-fragmentary lower pole patella fractures with minimum complications.

Effectiveness of Modified Tension Band Wiring for Medial Mallelous Fracture of Tibia

Introduction: Medial malleolus fracture is one of the commonest fractures. Non-operative approach may fail to produce anatomical reduction leading to ankle instability, nonunion and post traumatic osteoarthritis of the ankle. Proper anatomical reduction and stable internal fixation remains the key in treatment of displaced fracture. Good result had been achieved with Modified Tension Band Wiring. Aims:The purpose of our study was to evaluate the functional outcome of medial malleolus fracture treated with modified tension band wiring. Methods:This prospective observational study was conducted in department of Orthopaedics of Nepalgunj Medical College and Teaching Hospital from September 2018 to August 2021. Patients were evaluated for mode of injury, type of fracture, associated injury, radiological union, functional outcome, accompanying complications. All of the medial malleolus fractures in this study were treated by modified tension band wiring and outcomes were evaluated using Olerud and Molander Score. Results: In this study of 40 patients with the mean age of 41.60+13.75 year, 31(77.5%) were male and 9 (22.5%) were female. Majority of fractures were observed between 35 to 44 years, right side was predominantly involved, road traffic accident was the most common mode of injury. The average time duration of surgery from the time of injury was 5.25 days. Final functional outcome as per Olerud and Molander score showed, seven (17.5%) patients had excellent results, 30 (75%) patients had good results and three (7.5%) patients had poor results. The most common complication noted was hardware prominence at 7.5%, followed by superficial wound infection in 5% of patients. Conclusion: Modified Tension band wiring of medial malleolus results in good to excellent outcome in most of the patients with few complications .

Functional outcome of early movement of knee in transverse patellar fractures treated by modified tension band wiring

Background: The patella is the biggest sesamoid bone of the human frame located in front of the knee. Patellar fracture account for about one percent of all fractures and are most common within the age group of 20–50 years. Modified tension band wiring is the excellent for displaced transverse fractures. The principle of TBW is that tension forces at fracture site are converted to compression force. Materials and Method: This is a prospective study. This study was carried out at Sri aurobindo medical college and Pg institute during the period of January 2020 to May 2021. The functional status of the knee was analyse. Open reduction and internal fixation of the fractures were done by modified tension band wiring within 1week of fracture. Result: The mean age of the patients was 33.70 ± 6.73 years with a range from 23 to 49 years. There were 8 (40%) females and 12 (60%) males i, showing a male predominance. In 8 (40%) patients sustained injury due to fall and in 12 (60%) patients sustained injury due to road traffic accident. Conclusion: The modified tension band wiring is simple with a short period of learning curve, safe, inexpensive and effective technique in transverse fracture of patella because of good stability of implant, early joint mobilization with minimum complications and with easier post-operative rehabilitation.

Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures

BackgroundModified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications.ObjectiveThe study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture.Material and methodsWe present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores.ResultAll clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks.ConclusionFiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.

Functional outcome of surgical management in cases of fracture patella in a tertiary care hospital in Salem

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fractures of the patella are serious injuries with a broad range of subtypes. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 20-50 years. The underlying mechanisms of open fractures are mostly high-velocity accidents. To assess the functional outcome of various surgical procedures done for fracture patella.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A longitudinal study was conducted from the department of orthopedics, Vinayaka missions Kirupananda Variyar medical college and hospital, Salem for one year in August 2019 and July 2020. All the adult patients admitted with the diagnosis of patellar fracture were included in the study. A complete local examination was conducted and an X-ray of AP and the lateral view was taken for all the patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Transverse patella fracture is being the most common fracture and for that modified tension band wiring (TBW) was the most common procedure performed and for comminuted fracture partial patellectomy was the most common procedure and for 1 patient total patellectomy was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The study shows that the treatment of patella fractures with modified tension band wiring is a definitive treatment with minimal complications and excellent functional outcomes.&lt;/p&gt;

Management of displaced patella fracture with modified tension band wiring and percutaneous cannulated screws-a dilemma

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Displaced patella fracture has seen various surgical management methods in the past among which tension band wiring (TBW) and less invasive percutaneous cannulated cancellous (CC) screw fixation are mostly preferred and debated on which is better option. The study has been designed to compare the functional outcome and various parameters of both the methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study was conducted as prospective clinical study in 30 skeletally mature patients with x-ray evidence of patella fracture fulfilling inclusion and exclusion criteria, out of which 15 were done tension band wiring and rest percutaneous cancellous screw and outcome graded as excellent, good, fair and poor based on Lysholm knee score.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The comparison of the mean values of the Lysholm score in patients operated with patella TBW (92.47) were better than with percutaneous CC screw fixation (88.93). Patella TBW was responsible for all the cases of infection 2 (6.67%) and delayed non-union 1 (3.33%). Whereas stiff was nearly equal in both the techniques. The comparison of the mean values of the knee flexion in patients operated by using percutaneous CC screw (107.27) was better than patella TBW (105.67).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patients managed with CC screw fixation technique achieved better knee function, especially in the early postoperative period. The reported advantages of the percutaneous fixation technique include avoidance of extended incisions, preservation of the blood supply to the patella, and the possibility of a simpler removal of all hardware in the clinical setting. These results suggest that the percutaneous CC screw technique may be a superior alternative to conventional modified tension band wiring.&lt;/p&gt;

Biomechanical Analysis of the Kirschner-Wire Depth of the Modified Tension Band Wiring Technique in Transverse Patellar Fractures: An Experimental Study Using the Finite-Element Method.

BackgroudModified tension band wiring is one of the most preferred surgical methods for transverse patellar fractures. However, the optimal depth or sagittal position of a Kirschner wire (K-wire) in modified tension band wiring has yet to be determined. The purpose of this study was to evaluate whether the depth of a K-wire affects the biomechanical characteristics of modified tension band wiring using the finite-element method.MethodsA patella model was designed with a cuboid shape (length, 34.3 mm; width, 44.8 mm; and thickness, 22.4 mm) and divided into the cortical and cancellous bone parts. A transverse fracture line was formed on the midline of the cuboid shape model. The cuboidal model was applied to modified tension band wiring. The depth or sagittal position of the K-wire was divided into superficial, center, and deep. With the Abaqus v2017 program (Dassault System Inc.), the distal part of the model was fixed, and a tensile load of 850 N was applied to the proximal part of the model at an angle of 45°. The maximum pressures of the cortical and cancellous bones at the fracture plane were measured. The largest von Mises values of the K-wire and stainless steel wire were also measured. The fracture gap on the distracted or anterior side was measured.ResultsIn deep K-wire placement, the highest peak von Mises values of the cortical and cancellous bones were observed. The K-wire and stainless steel wire showed the highest von Mises values in deep K-wire placement. The fracture gap was also largest in deep K-wire placement.ConclusionsThe depth of the K-wire affects the biomechanical characteristics of modified tension band wiring. Deep placement of the K-wire will be more favorable for bone union than the empirically known 5-mm anterior or center placement of the K-wire.

Bilateral patella fracture with unilateral refracture: a case report

&lt;p class="abstract"&gt;Patella fracture consists of approximately 1% of all skeletal fractures. However bilateral patella fracture is even rarer (2-3% of all patella fractures) and is seen mostly in either dash board injuries or in different pathological conditions. A 21 year old male presented with bilateral patella fracture, where right patella was fractured due to RTA and the left one got fractured due to a fall while he was being helped for an X-ray for the first one. Bilateral tension band wiring was done and patient was being regularly followed up with good range of movement recovery. But again he had a fall in bathroom 3 month post-operative and on right side suffered a re-fracture. Modified tension band wiring was done. Patient gained full range of movement on both sides and returned to his normal activities at 9 months post op of index surgery. A case of bilateral patella fracture where mechanism of fracture for each patella fracture are different is unheard of. A case of bilateral patella fracture with re-fracture has not been reported yet in literature so far we know/ searched. Here we report and discuss the challenges in management of such a case and protocol we followed.&lt;/p&gt;