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

Abstract

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone.Keywords: Patella fracture, Tension band wiring, cerclage wiring

Clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by tension band wiring in a tertiary care hospital in North India: a prospective study

“…[17][18][19] Fractures were more common on the right side (59.1%), than on left side (40.9%) which were in agreement with previous studies Asimuddin et al and Mahindra et al 18,20 In the present study, 17 (%) were males and 5 (%) were females, with male to female (M: F) ratio of 3.4:1. Similar observations were made by Asimuddin et al, Ramu et al and Lone et al [20][21][22] In our study, the most common cause of fracture was road traffic accident (%), followed by fall (%), and assault which was similar to previous studies Asimuddin et al, Mohapatra et al and Mahindra et al 17,18,20 Table 3: Time of radiological union.…”

“…Our results were comparable with the existing literature Asimuddin et al, Mahindra et al and Lone et al 18,20,22 No neurovascular complications were observed in the present study.…”

“…Similar observations were made by Asimuddin et al, Mohapatra and Mahindra et al 17,18,20 The functional outcome was assessed on the basis of Reich and Rosenberg scale. 17,20,22 Out of 22 patients, complications were observed in 6 (27.3%) patients. Superficial Infection was noted in 3 patients, which was managed by thorough wound wash, intravenous antibiotics and regular sterile dressings.…”

Evaluation of the functional result of early knee mobility in transverse patellar fractures treated with modified tension band wiring

“…4%) had a fair outcome. The findings of our study were consistent with those of Asimuddin et al, Mohapatra, and Lone et al[10,13,15]. Among the 50 patients, problems were found in 17 individuals, representing a prevalence rate of 34%.…”

“…Hardware complications were seen in six individuals, leading to the removal of the implant after the fracture had fully healed. [11,13,15]. The current investigation did not notice any neurovascular problems.…”