Fixation of Comminuted Patellar Fracture with Combined Cerclage and Tension Band Wiring Technique

Abstract

In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is said to provide good mechanical stability. This is a retrospective review of four patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with a 1.25mm cerclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. The average follow-up period was 10 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. In all the cases, fracture union was achieved at an average of 11 weeks. The average ADLS score was good (92.5 %). Full range of knee motion was achieved by end of the third postoperative month. None of the patients had complications, such as infection and implant failure.

Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

“…Circumferential cerclage wiring added to the TBW has been regarded to improve the strength of the construct by some researchers. [17][18][19] Curtis, in a cadaveric study, concluded that the addition of cerclage wiring to the TBW significantly adds to the strength of the construct. 20 In present study, on the basis of inclusion and exclusion criteria, authors studied 54 cases of displaced transverse fractures of the body of patella from June 2017 to December 2018.…”

“…16 Although, TBW is the current gold standard for the displaced transverse patella fractures, few surgeons recommend augmentation of TBW with circumferential cerclage wiring to enhance the strength of the fixation. [17][18][19] Authors planned present study to compare the results of the displaced transverse patella fractures managed using TBW and circumferential cerclage wiring with the ones treated by TBW alone.…”

A comparative study of tension band wiring and encirclage in treating transverse fractures of patella

“…Patellar fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma. 1,2 The subcutaneous location of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. These fractures are usually transverse and are associated with tears of medial or lateral retinaculum.…”

Fixation of Comminuted Fracture of the Inferior Pole of the Patella Using Suture Anchors with Reinforcement by Ipsilateral Semitendinosus Tendon

“…Fracture fixation is an alternative to excision for treatment of comminuted inferior pole fractures to obtain an accurate reduction, rigid fixation and to restore the knee extension mechanism which allows early range of motion. However this is usually difficult to achieve due to the high degree of comminution of these fractures [10] .…”

“…Figure of eight wiring of the patella and tibia to protect the repair of Patellar tendon is an option but this caries the risk of breakage of the wire loop. Also the wire loop may cause anterior knee joint pain because of the tenting during knee movement [10] .…”