Early clinical outcome for transverse patellar fracture treated by tension band with 2 k-wires or 2 cannulated screws
DOI:
https://doi.org/10.22317/imj.v4i2.812Keywords:
patellar fracture, k wire, tension band, cannulated screwAbstract
Objectives: The goals of surgical treatment are to reestablish continuity of the extensor mechanism and to restore a smooth articular surface using stable internal fixation to permit early knee motion.
Methods: a comparative prospective study was done in Baghdad during the period from January 2016 till November 2019, we evaluated 50 patients with closed displaced (more than 3 mm) transverse patellar fracture, but only 44 patients complete the follow up divided into two groups (group 1) 22 patients was operatively treated by k-wires with tension band and (group 2) 22 patients was operatively treated by 2 cannulated screws with tension band. Both groups were evaluated for first 6 months after operation We evaluated the patients radiological, clinically and functionally every 2 months period by using the modified hospital for special surgery (HSS) knee score based on 4 standards clinical outcomes in which pain assessed by visual analog scale (vas), range of motion by goniometry, displacement on x ray, and quadriceps strength.
Results: in group1 male were (16 patients) 72% and female were (6 patients) 28%.in group2 male were(14patients) 64% and female were (8patients) 36% with a mean age of 32 year (20-55)year in group1 and 34year(26-57)year in group 2.The VAS scores showed that the group2 had lower pain scores and better
range of motion (ROM) compared to group1. quadriceps strenghth more than 75% in group 2 and no fracture displacement as compared with group 1excellent and good results were (63%) in group1and (81%) in group 2.Poor and fair results were (36%) in group1 and (18%) in group2.
Conclusion: fixation of patellar fracture(closed, transverse, in adult) by 2 cannulated screws and tension band is superior to tension band with 2 k-wires with less complications.
References
2. Dath R, Chakravarthy J, Porter KM. Patella dislocations. Trauma. 2006 Jan;8(1):5-11.
3. Mehling I, Mehling A, Rommens PM. Comminuted patellar fractures. CurrOrthop. 2006;20(6):397–404.
4. Hoshino CM, Tran W, Tiberi III JV, Black MH, Li BH, Gold SM, Navarro RA. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. JBJS. 2013 Apr 3;95(7):653-9.
5. Nummi J. Fracture of the patella. A clinical study of 707 patellar fractures. InAnnales chirurgiae et gynaecologiae Fenniae. Supplementum 1971 (Vol. 179, pp. 1-85).
6. Galla M, Lobenhoffer P. Patella fractures. Chirurg. 2005;76(10):987–99.
7. Dargel J, Gick S, Mader K, Koebke J, Pennig D. Biomechanical comparison of Tension band- and interfragmentary screw fixation with a new implant in Transverse patella fractures. Injury. 2010;41(2):156–60.
8. 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.
9. Mehling I, Mehling A, Rommens PM. Comminuted patellar fractures. CurrOrthop2006;20(6):397–404.
10. Lazaro LE, Wellman DS, Sauro G, et al. Outcomes after opera¬tive fixation of complete articu¬lar patellar fractures: assess¬ment of functional impairment. J Bone Joint Surg Am. 2013; 95(14):e96.
11. Banks KE, Ambrose CG, Wheeless JS, Tissue CM, Sen M. An alternative patellar frac¬ture fixation: a biomechanical study. J Orthop Trauma. 2013; 27(6):345-351.
12. Carpenter JE, Kasman R, Mat¬thews LS. Fractures of the pa¬tella. Instr Course Lect. 1994; 43:97-108.
13. ROCKWOOD C.A,GREEN D,fractures in adult rockwood and green 4thed.lippincott-raven 1996,167-171
14. Biddau F, Fioriti M, Benelli G. Migration of a broken cer¬clage wire from the patella into the heart: a case report. J Bone Joint Surg Am. 2006; 88(9):2057-2059.
15. Edwards, Birgitta, Olof Johnell, and Inga Redlund-Johnell. "Patellar fractures A 30-year follow-up." Acta Orthopaedica Scandinavica 60.6 (1989): 712-714.
16. Edwards, Birgitta, Olof Johnell, and Inga Redlund-Johnell. "Patellar fractures A 30-year follow-up." Acta Orthopaedica Scandinavica 60.6 (1989): 712-714.
17. Levack, B., J. P. Flannagan, and S. Hobbs. "Results of surgical treatment of patellar fractures." The Journal of bone and joint surgery. British volume 67.3 (1985): 416-419.
18. Liang, Q. Y., and J. W. Wu. "Fracture of the patella treated by open reduction and external compressive skeletal fixation." JBJS 69.1 (1987): 83-89.
19. Berg, Eugene E. "Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws." Journal of orthopaedic trauma 11.8 (1997): 573-576.
20. Smith, Scott T., et al. "Early complications in the operative treatment of patella fractures." Journal of orthopaedic trauma 11.3 (1997): 183-187.