Nagakiran K.V.1, Sameer Wooly2, Prasad Soraganvi3, Sudeep Madhukar Nambiar4, H. Balakrishna Gadiyar5, C.N. Raju6, Nallani Manasa7, G. Rajkamal8
BACKGROUND
Patella is a sesamoid bone that plays an important role in the extensor apparatus
of the knee joint. Fractures of the patella constitute about 1 % of all fractures.
Definitive treatment of the patellar fractures depends on the type of fracture,
displacement, joint congruity, and intactness of the extensor apparatus. There is
significant controversy about the surgical options for displaced patellar fractures.
Although conventionally tension band wiring using K-wires (TBW-K wire) is a
common procedure, tension band wiring using cancellous screws (TBW-CCS) is
gaining popularity. A study was undertaken to compare outcomes between the
two procedures (TBW-CCS & TBW-K wire).
METHODS
A prospective randomised study was planned. Inclusion & exclusion criteria were
laid down. Institutional ethical committee clearance was obtained. 68 consenting
patients with transverse patellar fractures underwent surgery (TBW-CCS or TBWK
wire) after randomisation. Demographic, clinical, and radiological assessment
was done. Bostman score was used as an outcome measure. Statistical analysis
was done.
RESULTS
85.5 % of cancellous screw group patients had excellent outcome scores as
against 41.2 % in the K wire group. The difference was statistically significant.
5.8 % of patients in the cancellous group complained of implant prominence as
against 17.6 % in the K wire group which was statistically significant as well.
Patients in TBW-CCS had a statistically significant difference in Bostman scores
at 6 weeks, 3 months, and 6 months.
CONCLUSIONS
Tension band wiring with cannulated cancellous screws is a safe and reliable
technique in the management of transverse patellar fractures with fewer chances
of implant failure and soft tissue irritation. Based on our study, tension band
wiring with cannulated cancellous screws is a better method to treat transverse
fractures of the patella when compared to the modified tension band wiring
technique using K-wire.
