A modified wire tension band technique for treatment of comminuted displaced patellar fractures

Abstract

Purpose: Wire tension band technique, as a widely accepted strategy for the treatment of patellar fractures, is undergoing constant improvement. This study aims to assess the clinical effect of a modified wire tension band technique for treatment of comminuted displaced patellar fractures. Methods: From January 2015 to December 2021, 97 adult patients (52 males and 45 females) with comminuted displaced patellar fractures were treated with wire tension band technique in our department. The age ranged from 18 to 68 years old with an average of 39 years old. All patients had single closed comminuted displaced patellar fractures and all were treated with open reduction internal fixation. There were 58 patients in the modified wire tension band group (The MW group) and 39 patients included in the Kirschner wire tension band group (The KW group). Operating time, intraoperative bleeding, length of hospital stay, postoperative follow-up, fracture healing time, and knee motion and function scores were recorded and compared between the two groups. The incidence of postoperative complications such as non-union of the fracture, infection, failure of the internal fixation, re-fracture, and broken of the internal fixation were recorded and evaluated. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. VAS (Preoperative and last follow-up scores in the Visual Analogue Scale) and Böstman scale were recorded and evaluated. Results: There were no significant differences in basic information such as age, gender, BMI, mechanism of injury, history of smoking and alcohol, injured limb and follow-up time in the MW group compared to the KW group. Intraoperative time (49.91±3.88, min ) in the MW group was significantly lower than intraoperative time (67.64±4.27, min) in the KW group and the difference was statistically significant (P＜0.05). In the MW group (102.59±10.01, ml), intraoperative blood loss was significantly lower than in the KW group (126.41±13.86, ml), and the difference between the two groups was statistically significant(P＜0.05). The intraoperative time of fluoroscopy in the MW group was (8.14±1.82, s), which was lower than the intraoperative time of fluoroscopy in the KW group (10.41±1.67, s), and the difference between the two groups was statistically significant(P＜0.05). The hospital days were also significantly shorter in the MW group (6.07±1.23, d) than in the KW group (6.79±1.42, d). The difference was statistically significant(P＜0.05). There was no significant difference between the two groups in terms of fracture healing time, mobility, VAS score and Böstman score after surgery. There were no complications such as infection or non-healing fractures. However, there were 2 cases of wire fracture complications in both the MW and KW groups when the internal fixation was removed. Conclusion: The modified wire tension band technique for fixation of patellar fractures is an effective new technique for the safe and reliable management of patellar fractures and offers an alternative strategy for the treatment of patellar fractures.