A Modified Tension Band Fixation Technique for the Management of Patellar Fractures Using Crossed Pins and a Lateral Parapatellar Approach

Abstract

The use of the tension band technique for patellar fracture fixation has been associated with a loss of the rigidity of the construct after cyclic loading. Biomechanical studies have shown the biomechanical superiority of the crossed pin configuration relative to the traditional parallel one. Here, we describe a modified tension band technique that involves the use of crossed pins and a figure-of-eight passed as close to the bone as possible through a lateral parapatellar approach. The basic surgical technique and our case series are reviewed.

Ring-Pins combined with cable cerclage for the fixation of displaced inferior patellar pole fractures

“…Inferior patellar pole fractures are a distinct group of completely extra-articular avulsion injuries, usually measuring less than 15 mm in vertical length ( 2 , 9 ). The key point of operation is to effectively fix the main fragment of the inferior pole fracture to allow early movement of the knee.…”

“…Ideal operation methods should be sufficient fixation stability, a relatively simple surgical procedure, and early motion of the injured knee. K-wire fixation with tension band wiring is still the most frequent method to treat transverse patellar fractures, and it can provide sufficient fixation stability according to the theory of tension band ( 3 , 9 ). However, there is an inherent disadvantage for conventional K-wires, such as migration and breakage, with the subsequent painful and prominent implant in the knee.…”