Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring

INTRODUCTION

The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures.

MATERIALS AND METHODS

A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed.

RESULTS

73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1 day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6 m than the TBW group (6.4 ± 7.4 m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups.

CONCLUSIONS

The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

Predictors of postoperative complications of tension band wiring techniques for patella fracture: A retrospective multicenter (TRON group) study

OBJECTIVE

The relationship between postoperative complications and operative techniques of tension band wiring (TBW) is not well studied. We aimed to evaluate the incidence of implant breakage, implant migration, and loss of reduction in patellar fractures treated with TBW and identify radiographic factors associated with these postoperative complications.

METHODS

This multicenter (named, TRON group) retrospective study included 224 patients who underwent open reduction and internal fixation of patella fractures using TBW from January 2016 to December 2020. Radiographic findings were evaluated by experienced orthopedic surgeons, and radiographic outcomes were assessed for K-wire migration, implant breakage, and loss of reduction. Logistic regression analysis was performed to identify radiographic factors associated with postoperative complications.

RESULTS

Implant migration occurred in 44 cases (19.6%), with bending of a single K-wire end identified as a significant risk factor (OR: 12.90; 95% CI: 4.99-33.30; P < 0.001). Implant breakage occurred in 43 cases (19.2%), with a large patella-tension band ratio (OR: 291.0; 95% CI: 19.60-4330; P < 0.001) and a wide distance between K-wires (OR: 1.15; 95% CI: 1.060-1.250; P = 0.001) identified as significant risk factors. Loss of reduction occurred in 5 cases (2.0%), but no significant risk factors were identified.

CONCLUSION

This study highlights the importance of bending both ends of the K-wires and proper placement of the tension band and K-wires in reducing postoperative complications in patellar fractures treated with TBW. Further research is needed to better understand the risk factors associated with loss of reduction.

Prospective Comparative Study of Fixing Displaced Transverse Patellar Fracture by Tension Band Wiring Versus Cannulated Screws with Wiring

BACKGROUND: Transverse fractures of the patella are important fractures with a wide variety of subtypes, the common incidence in the age group of 20–50 years. Surgical interference aims to achieve a perfect alignment of the joint surface, in addition to rigid fixation of the fracture for early re-habitation and early movement to retain the extensor mechanism of the knee joint. AIM: The aim of this study was to compare the radiological and functional outcomes of the displaced transverse patella fracture in adult patients treated by ORIF using tension band wiring versus cannulated screws with wiring. METHODS: A prospective analytic comparative study was conducted in Al-Kindy Teaching Hospital/Baghdad/Iraq for 18 months from April 1, 2019, to October 1, 2020. It included 32 patients with isolated displaced transverse patellar fracture AO type 34-C1. The patients have undergone operative fixation with two different surgical techniques divided randomly by choosing every other patient into two groups. Group A, the fracture was fixed by cannulated screws with wiring and Group B, the fracture was fixed by two K-wires and with tension band technique. Postoperatively, assessment of the knee function by Lysholm score, the visual analog scale for pain intensity, and active flexion range of movement were measured in degree as primary outcomes, while time to union in weeks assessed radiographically as secondary outcomes. RESULTS: The patients’ age was ranging from 26 to 49 years, with males predominant. Low-energy falls occupying a major part of the mechanism of injury in both groups. Lysholm score was significantly increased after 3, 6, and 12 months compared to that after 1 month in both groups with no statistical differences. The mean visual analog score significantly decreased in Group A after 1 month than that in Group B with no significant change in the other follow-up periods. There were no statistically significant differences in both groups regarding the range of knee movement and the radiographic assessment of fracture healing. CONCLUSION: Both techniques are good and effective with taking into consideration that open reduction and cannulated screws fixation with wiring technique is shown to be associated with lower post-operative pain and a lower frequency of complications mainly surgical site infection.

"Fishing net" suture augmenting tension-band wiring fixation in the treatment of inferior pole fracture of the patella

INTRODUCTION

Inferior pole fracture of the patella (IPFP) is difficult to repair and stabilize clinically. Although various fixation techniques have been developed, fixation strength and mobility remain daunting challenges to orthopedic surgeons. The goal of this research is to evaluate the biomechanical strength and clinical outcomes of a novel "fishing net" suture fixation procedure.

MATERIALS AND METHODS

Four finite element models, modified tension-band wiring fixation, anchor suture fixation, basket plate fixation and "fishing net" suture fixation were built to compare the fixing efficacy of "fishing net" suture fixation with three other fixation methods during IPFP fixation. From January 2018 to February 2019, 17 patients who suffered IPFP and treated by "fishing net" suture (FNS) fixation were compared with 20 patients treated by tension-band wiring (TBW) fixation in database and the two groups were evaluated postoperatively using the modified Cincinnati knee rating system.

RESULTS

Biomechanical evaluation showed that the relative displacement values of proximal patella measured by three pairs of points on both sides of the fracture line were the lowest using the "fishing net" suture fixation, while fixation using tension-band wiring and basket plate showed similar levels of stability that were less desirable than the "fishing net" method. As to clinical outcomes, there were 17 (100%) patients exhibited excellent or good results with no internal fixation failures in the FNS group compared to three internal fixation failures in the TBW group.

CONCLUSION

The biomechanical and clinical results suggest that the "fishing net" suture fixation is a viable candidate for fixation of IPFP.

Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study

PURPOSE

To compare functional and radiological outcomes of transverse patella fractures treated with tension band wiring using either two 4.5 mm cannulated screws or Kirshner wire.

METHODS

This is a non-blinded prospective randomized study comprising of two groups (n = 30 each) with closed transverse patella fractures treated with tension band wiring using Kirschner wire (K wire group) and two 4.5 mm cannulated screws (CCS group). Outcomes measured were radiological union, Knee Society score, range of motion and post-operative complications.

RESULTS

The CCS group showed a statistically significant higher range of motion than K wire group for each follow up (p < 0.001 in flexion and p < 0.005 in extension). A statistically significant higher percentage of patients in the CCS group showed signs of union at 6th and 12th post-operative week (p = 0.001 and 0.011 respectively) but no difference at 24th post-operative week (p = 0.313). The rate of hardware complications was significantly higher in K wire group (p = 0.001). No significant difference was noted in in the Knee society score and post-operative complications between the groups.

CONCLUSION

This study concludes that the fixation of closed transverse patella fractures using two 4.5 mm cannulated screws is allows a faster rate of union, a better knee range of motion and lesser hardware complications as compared to Kirschner wires. However more studies with larger sample sizes and longer follow up are required.