Treatment of comminuted patellar fractures using modified cerclage wiring

Abstract

Background: Comminuted patellar fracture is still challenging. It is essential to restore the articular cartilage with rigid internal fixation. Aim of the study: was to assess the outcome of modified cerclage wiring fixation in patients with comminuted patellar fracture. Patients and Methods: This study was done in orthopedic surgery department at Al-Azhar University Hospitals, during the period from December 2019 to November 2020. A total of 15 patients with comminuted fracture of patella were maneged by modified cerclage wiring. 12 patients were males (80.0%) and 3 patients were females (20.0%). Their age was 18-64 (average 38.87±14.80) years. All patients had unilateral patellar fractures. The fractures were closed in 12 patients (80.0%) and open in 3 patients (20.0%). We followed up our patients for at least 6 months. Böstman grading score was the main clinical outcome indicator. Results: The fracture union occurred radiologically about 2-3.5 months (mean 2.70±0.46 months). 2 cases had self-limited postoperative superficial infection. No postoperative complications such as fragment re-displacement, implants breakage, , painful hardware and non-union were observed. Clinical outcomes according to grading score of Böstman were satisfactory and the average score was 28.13±1.73 (range 24-30) points. 12 patients had excellent results with an average score of 28.8 ± 0.71 (range 28-30) points and 3 patients had good results with an average score of 25.33±1.53 (range 24-27) points. All patients had knee flexion 110-140 (mean 127.33±9.61) degrees. Conclusion: Modified cerclage wiring fixation offers a new technique in comminuted patellar fracture treatment with satisfactory results and minimal complications.