Inter-fragmentary compression using cannulated cancellous screws augmented with modified tension band wiring in transverse patella fractures
Keywords:Transverse patella fractures, Tension band wiring, Cannulated cancellous screw, Tegner lysholm score
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.
Rüedi TP, Buckley RE, Moran CG. AO principles of fracture management. Thieme. 2007.
AOF. Fracture Classifications, 2012. Available at: www.aofoundation.org. Accessed on 11 September 2023.
Muzaffar N, Ahmad N, Ahmad A, Ahmad N. The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures. Trop Doct. 2012;42(1):25-7.
Lotke PA, Ecker ML. Transverse fractures of the patella. Clin Orthop Relat Res. 1981;(158):180-4.
Eggink KM, Jaarsma RL. Mid-term (2-8 years) follow-up of open reduction and internal fixation of patella fractures: does the surgical technique influence the outcome? Arch Orthop Trauma Surg. 2011;131(3):399-404.
Chaudhary R, Joshi A, Bajaracharya AR. Functional Outcome of Modified Tension band wiring in Transverse Fracture of Patella. Post-Graduate Med J NAMS. 2015;15(01).
Lefaivre KA, O'Brien PJ, Broekhuyse HM, Guy P, Blachut PA. Modified tension band technique for patella fractures. Orthop Traumatol Surg Res. 2010;96(5):579-82.
Chiang CC, Chen WM, Jeff Lin CF, Chen CF, Huang CK, Tzeng YH, et al. Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures. J Chin Med Assoc. 2011;74(7):316-21.
Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg. 2011;19(4):198-207.
Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. J Orthop Trauma. 1997;11(8):573-6.
Moneim A, Mohammed HM. Outcome of Transverse Patella Fractures Fixed With Cannulated Screws and Stainless Steel Tension Band Wiring. Res Square. 2021;1-16.
Vij K, Kothiyal P, Gupta P, Paul N, Yadav V. Evaluation of patella fractures managed by augmented cannulated cancellous screw fixation: A prospective study. Int J Orthop 2021;7(4):331-4.
Burvant JG, Thomas KA, Alexander R, Harris MB. Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study. J Orthop Trauma. 1994;8(2):147-53.
Carpenter JE, Kasman RA, Patel N, Lee ML, Goldstein SA. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma. 1997;11(5):351-6.
Revs IJ. Functional outcome of transverse patella fractures treated with cannulated cancellous screw and tension band wiring. Int J Modn Res Revs. 2015;3(10):1023-8.
Khan I, Dar MY, Rashid S, Butt MF. Internal Fixation of Transverse Patella Fractures Using Cannulated Cancellous Screws with Anterior Tension Band Wiring. Malays Orthop J. 2016;10(2):21-6.