Comparison of the outcomes of pull through suturing vs. tension band wiring fixation techniques in the management of patellar fractures
Keywords:Patella, Lysholm knee score, Tension band wiring, Pull through suturing
Background: Operative fixation of displaced patella fractures has now become the standard of care. This study aims to asses functional outcomes, as well as identify complications in a patients treated with non-absorbable braided suture fixation for patellar fractures. These patients were then compared to a group of patients treated with K-wires with tension band wiring.
Methods: This study was conducted on the patients admitted to orthopaedic ward at MGM medical college and hospital, Kamothe, Navi Mumbai. Total number of patients was taken for this study. Patients were followed up for a period of 6 weeks, 3 months, 6 months and at each visit. Patients were assessed by Lysholm knee score.
Results: The mean age was 43.33 years for TB wiring group and 46.26 years for pull through suturing group. Out of 30, 15 were in TB wiring group in which 14 males and 1 female and, 15 in pull through suturing group 4 females and 11 males. The mean Lysholm knee score at 6 weeks for TB wiring group was 68.2 at 3 months was 81.4 at 6 months was 87. The mean Lysholm knee score for 6 weeks for pull through suturing was 69.2, at 3 months was 72.5 and at 6 months was 79.2.
Conclusions: Patella fracture most common fractures, in this study we have discussed two modalities of treatment one is TB wiring and second is pull through suturing showing results that TB wiring have better results.
Mehling I, Mehling A, Rommens PM. Comminuted patellar fractures. Curr Orthop. 2006;20(6):397–404.
Hughes SC, Stott PM, Hearnden AJ, Ripley LG. A new and effective tension-band braided polyester suture technique for transverse patellar fracture fixation. Injury. 2007;38(2):212–22.
Chiang CC, Huang CK, Chen WM, Lin CF, Tzeng YH, Liu CL. Arthroscopically assisted percutaneous osteosynthesis of displaced transverse patellar fractures with figure-eight wiring through paired cannulated screws. Arch Orthop Trauma Surg. 2011;131(7):949–54.
Whittle PA, Wood GW. Fractures of lower extremity. In: Terry Canale S, editor. Campbell’s Operative Orthopaedic. 10. Philadelphia, PA: Mosby; 2006: 2725–2872.
Tian Y, Zhou F, Ji H, Zhang Z, Guo Y. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures. Clin Orthop Relat Res. 2011;469(12):3429–35.
Wardak MI, Siawash AR, Hayda R. Fixation of patella fractures with a minimally invasive tensioned wire method: compressive external fixation. J Trauma Acute Care Surg. 2012;72(5):1393–8.
Mao N, Ni H, Ding W, Zhu X, Bai Y, Wang C, et al. Surgical treatment of transverse patella fractures by the cable pin system with a minimally invasive technique. J Trauma Acute Care Surg. 2012;72(4):1056–61.
Wild M, Eichler C, Thelen S, Jungbluth P, Windolf J, Hakimi M. Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring? Clin Biomech (Bristol, Avon). 2010;25(4):341–7.
Rathi A, Swamy MK, Prasantha I, Consul A, Bansal A, Bahl V. Percutaneous tension band wiring for patellar fractures. J Orthop Surg (Hong Kong). 2012;20(2):166–9.
Tandogan RN, Demirors H, Tuncay CI, Cesur N, Hersekli M. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures. Arthroscopy. 2002;18(2):156–62.
Gardner MJ, Griffith MH, Lawrence BD, Lorich DG. Complete exposure of the articular surface for fixation of patellar fractures. J Orthop Trauma. 2005;19(2):118–23.
Qi L, Chang C, Xin T, Xing PF, Tianfu Y, Gang Z, et al. Double fixation of displaced patella fractures using bioabsorbablecannulated lag screws and braided polyester suture tension bands. Injury. 2011;42(10):1116–20.
Thelen S, Schneppendahl J, Baumgärtner R, Eichler C, Koebke J, Betsch M, et al. Cyclic long-term loading of a bilateral fixed-angle plate in comparison with tension band wiring with K-wires or cannulated screws in transverse patella fractures. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):311–7.
El-Sayed AM, Ragab RK. Arthroscopic-assisted reduction and stabilization of transverse fractures of the patella. Knee. 2009;16(1):54–7.
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.
Luna-Pizarro D, Amato D, Arellano F, Hernández A, López-Rojas P. Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial. J Orthop Trauma. 2006;20(8):529–35.
Mao N, Liu D, Ni H, Tang H, Zhang Q. Comparison of the cable pin system with conventional open surgery for transverse patella fractures. Clin Orthop Relat Res. 2013;471(7):2361–6.
Hoshino CM, Tran W, Tiberi JV, Black MH, Li BH, Gold SM, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am. 2013;95(7):653–9.
Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early complications in the operative treatment of patella fractures. J Orthop Trauma. 1997;11(3):183–7.
Scilaris TA, Grantham JL, Prayson MJ, Marshall MP, Hamilton JJ, Williams JL. Biomechanical comparison of fixation methods in transverse patella fractures. J Orthop Trauma. 1998;12:356–9.
Najibi S, Banglmeier R, Matta J, Tannast M. Material properties of common suture materials in orthopaedic surgery. Iowa Orthop J. 2010;30:84–8.
Wright PB, Kosmopoulos V, Cote RE, Tayag TJ, Nana AD. Fiber Wire is superior in strength to stainless steel wire for tension band fixation of transverse patellar fractures. Injury. 2009;40:1200–3.
Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med. 1982;10:150–4.
Gosal S, Singh P, Field E. Clinical experience of patellar fracture fixation using metal wire or non-absorbable polyester. Injury, Int J Care Injured 2001;32:129–35.
Yotsumoto T, Nishikawa U, Ryoke K, Nozaki K, Uchio Y. Tension band fixation for treatment of patellar fracture:Novel technique using a braided polyblend sutures and ring pins. Int J Care Injured. 2009;40:713–7.
Fortis AP, Milis Z, Kostopoulos V, Tsantzalis S, Kormas P, Tzinieris N, et al. Experimental investigation of the tension band in fractures of the patella. Injury, Int J Care Injured. 2002;33:489–93.