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

Abstract

Background. Patella fracture accounts for 1% of bone injury, of which anatomical reduction is of great significance to the recovery. Tension band with cannulated screw and Kirschner wire is commonly used methods for the treatment of displaced patella fracture. However, there is still some controversy on the clinical efficacy of the two treatment methods. Objective. This study aimed at comparing the therapeutic effects of the cannulated screw and Kirschner wire tension bands on patella fracture and at providing more data basis for clinical selection of treatment methods for patella fracture. Methods. Altogether, 146 patients with displaced patella fracture admitted to our hospital from March 2016 to February 2018 were selected and divided into two groups according to the different treatment methods. Among them, 71 patients received tension band with a cannulated screw (TBWCS group) and 75 patients received tension band with Kirschner wire (TBWKW group). Two groups of patients were compared in terms of surgical treatment effect after one year of treatment, complications within six months after the operation and operation-related indexes. The pain visual analogue scale (VAS) score, knee flexion degree, Lysholm score, and Bostman score were recorded at 1, 3, 6, and 12 months after operation, and the activity of daily living scale (ADL) score was evaluated at the last follow-up. Results. During the operation of patella fracture patients, the intraoperative blood loss, hospitalization time, and knee flexion loss of patients in TBWCS group were less than those in the TBWKW group (P<0.05), the starting time of postoperative functional exercise was earlier than that of patients in TBWKW group (P<0.05), and the incidence rate of secondary operation was lower than that of patients in the TBWKW group (P<0.05), but there was no statistical difference in the operation time, incision length, and postoperative fracture gap between the two groups. The results of curative effect analysis showed that the knee flexion, Lysholm score, and Bostman score of patients treated with tension band with cannulated screw were higher than those treated with Kirschner wire (P<0.05), and VAS score was lower. Tension band with cannulated screw had a better curative effect on patella fracture (P<0.05), lower complication rate (P<0.05), and higher quality of life of patients (P<0.05). Conclusion. Tension band with cannulated screw has a good curative effect on patella fracture, low incidence of complications, early start of postoperative functional exercise, and high quality of life.

Evaluation of Internal Fixation of Patellar Fractures Using Cannulated Screws with Tension Band versus Modified Tension Band Wiring

“…There were no statistically significant differences between the two groups, including age, side, gender, fracture classification, mechanism, fracture displacement, and operative time to injury.The average age of the 52 patients was 51.7 years old (range, 22-76 years old).In our study 5 patients (16.7%) had loss of knee motion, four of them were treated by Kwires, 5 patients (16.7%) had loss of reduction or implant failure, four of them were treated by K-wires, 6 patients (20%) had delayed or non-union, five of them were treated by Kwires, 10 patients (33.3%) had pain during movement, seven of them were treated by Kwires. By comparison between types of fixation among post-operative complication (loss of knee motion, loss of reduction, delayed or non-union and pain during movement) there was no statistically significant difference between (loss of knee motion, loss of reduction, delayed or nonunion and pain during movement) among types of fixation, which is in agreement with the study of Liu et al[10] which reported there was no significant difference in the incidence of knee joint movement limitation, traumatic arthritis, bursitis, displaced internal fixation, reduction loss, and delayed fracture healing between the two groups, but the total incidence of complications in the TBWCS group was lower than that in the TBWKW group.…”

Metallic Implants for Patellar Fracture Fixation: A Systematic Review

“…They concluded that TBCS had better functional scores, quality of life, post-operative pain, and lower complication rate than TBKW. However, operative time was not significantly different (23) .…”

“…The shortest period (mean 1.72 months)was related to the TBCS group in the Hancerli study (22) . the longest period for union (mean3.3 ±0.7 months) was related to the TBKW group in the Liu study (figure 3) (23) Complications and Hardware Failure; Non-favorable outcomes were reported in all studies. The risk of complications with TBKW was statistically higher than that with TBCS (OR = 0.26, 95% CI ) (p=0.004) figure 5.…”

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

“…With the extensive use of tension banding techniques and the continuous development of innovative fracture xation techniques, many studies have been conducted to improve the tension band technique. Some studies 12,24 have used two parallel Kirschner wires or hollow screws through the fracture plane in combination with a wire tension band to x patellar fractures. However, this can only be used for simple patellar fractures.…”