LOWER POLE PATELLA FRACTURE: A COMBINATION OF CANCELLOUS SCREW FIXATION AND TENSION BAND WIRING Date : 30-07-2014

Abstract

ABSTRACT:The fracture of the lower pole of the patella is a common type of fracture of the patella. The treatment involves internal fixation or excision of the lower fragment. This study was undertaken to study the efficacy of cancellous screw fixation combined with tension band wiring in the treatment of these fractures. Twenty patients with lower pole patellar fractures were treated by this technique and evaluated by Gaur's criteria for knee evaluation. Excellent good results were noted in 19 cases and fair result in one case. There were no poor results and there were no major complications hence it was concluded that cancellous screw fixation combined with tension band wiring is a good method for treating lower pole patellar fractures. KEYWORDS: Distal Pole Patella, Fracture, Cancellous Screw, Encerclage. INTRODUCTION:Fracture of the patella constitutes almost 1% of all skeletal injury 1 and fracture of the lower pole of the patella is a commonly encountered type of fracture patella. The fracture patella occurs as a result of direct or indirect force. 2, 3 It is twice as common in men as women. 2 Fracture of the lower pole is commonly an avulsion injury as a result of violent contraction of the quadriceps muscle or as a result of subluxation or dislocation of patella 4 especially as a sports injury occurring in young individuals. Hence there is more likelihood of extensive retinacular tear. 2 This retinacular tear precludes conservative treatment and operative treatment is the mainstay of lower pole patellar fractures.Various treatment modalities have been advocated for fracture of the lower pole of patella including Magnusson wiring, cancellous screw fixation, tension band wiring, cerclage wiring, fixation of the lower pole augmented by a patellotibial SS wire loop, basket plate fixation and excision of the lower pole of the patella. [1][2][3][5][6][7][8] However in spite of having these myriad of options for treatment there is no consensus about the treatment of choice for these fractures. Some surgeons prefer excision of the lower pole with fixation of the patellar tendon to the upper fragment by non-absorbable sutures and others swear by internal fixation as the better method of treatment 5 . This study was undertaken to evaluate the efficacy of cancellous screw fixation augmented by tension band wiring in fractures of lower pole of patella.

Evaluation of Results of Separate Vertical Wirings for the Treatment of Extra-articular Fractures of the Distal Pole of the Patella

“…Treatments vary Magnusson wiring, separate vertical wiring, cancellous screw fixation, tension band wiring, cerclage wiring, fixation of the lower pole augmented by a patellotibial SS wire loop, basket plate fixation, and excision of the lower pole of the patella each have their own advantages and disadvantages. Despite the many therapeutic choices, there is no consensus on how to treat these fractures [6]. After removing bone pieces, the patellar tendon is usually attached by transosseous pull-out suture.…”