Complications Related to Implant Fixation of Patellar Fractures: Comparison of Ring Pins versus Bent K-Wires

2016 ◽  
Vol 30 (06) ◽  
pp. 560-564 ◽  
Author(s):  
Min Kyung ◽  
Seung Lee ◽  
Min Kim
Keyword(s):  
Tension Band ◽  
Implant Removal ◽  
Tension Band Wiring ◽  
The Novel ◽  
Implant Migration ◽  
Group 2 ◽  
K Wires ◽  
Patellar Fractures ◽  
Ring Pin ◽  
Group 1

AbstractPatellar fractures are characterized by injuries to the extensor and typically require surgical fixation. Among the methods used for fixation, the most common is the modified AO tension-band wiring technique. However, using this technique, implant migration occurs due to the lack of connections between the K-wires and the tension-band wire, which causes irritation and reduces fracture stability. Recently, new methods for tension-band wiring have been developed in which tension bands lock the K-wires through an attached “ring” to prevent migration. The purpose of this study was to compare the clinical outcomes when either the conventional or novel technique was used for tension-band wiring. This was a retrospective study involving 48 patients who underwent tension-band wiring to correct a patellar fracture. Patients in group 1 (n = 23) were treated between December 2010 and February 2012 using conventional tension-band wiring, while patients in group 2 (n = 25) were treated between March 2012 and May 2014 using the novel ring pin method. Different surgeons performed the operations in the two groups, while all other conditions were consistent. The surgical outcomes were assessed according to the level of implant migration, irritation, and implant removal procedures. All patients in group 2 achieved a union of the patella, while two patients in group 1 did not. These two patients underwent partial patellectomy within 1 year of the initial surgery. Implant migration and removal were significantly more common among patients in group 1 (p = 0.0038 and 0.011, respectively), with the implant removal period being significantly shorter as well (p = 0.005). The novel ring pin method was superior to the conventional method in terms of preventing implant migration, removal, or other secondary operations for the correction of complications.

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

2019 ◽  
Vol 7 (5) ◽  
pp. 1752
Author(s):  
Zubair A. Lone ◽  
John Mohd ◽  
John Mohd ◽  
Imtiyaz A. Beigh ◽  
Imtiyaz A. Beigh ◽  
...  
Keyword(s):  
Tension Band ◽  
Tension Band Wiring ◽  
P Value ◽  
Fixation Failure ◽  
Non Union ◽  
Recommended Treatment ◽  
Cerclage Wiring ◽  
Group 2 ◽  
Transverse Fractures ◽  
Group 1

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 

scholarly journals Biomechanical comparison of bi- and tricortical k-wire fixation in tension band wiring osteosynthesis

2019 ◽  
Vol 24 (1) ◽  
Author(s):  
J. Nowotny ◽  
F. Bischoff ◽  
T. Ahlfeld ◽  
J. Goronzy ◽  
E. Tille ◽  
...  
Keyword(s):  
Cost Effective ◽  
Tension Band ◽  
Tension Band Wiring ◽  
High Rate ◽  
Failure Behavior ◽  
Pullout Strength ◽  
Wire Fixation ◽  
Group 2 ◽  
K Wires ◽  
Biomechanical Comparison

Abstract Background Patients with a simple transversal fracture of the olecranon are often treated with a tension band wiring (TBW), because it is known as a biomechanically appropriate and cost-effective procedure. Nevertheless, the technique is in detail more challenging than thought, resulting in a considerable high rate of implant-related complications like k-wire loosening and soft tissue irritation. In the literature, a distinction is generally only made between transcortical (bi-) and intramedullary (mono-) fixation of the wires. There is the additional possibility to fix the proximal bent end of k-wire in the cortex of the bone and thus create a tricortical fixation. The present study investigates the effectiveness of bi- and tricortical k-wire fixation in a biomechanical approach. Methods TBW of the olecranon was performed at 10 cadaver ulnas from six donors in a usual manner and divided into two groups: In group 1, the k-wire was inserted by bicortical fixation (BC), and in group 2, a tricortical fixation (TC) was chosen. Failure behavior and maximum pullout strength were assessed and evaluated by using a Zwick machine. The statistical evaluation was descriptive and with a paired t test for the evaluation of significances between the two techniques. Results The average age of the used donors was 81.5 ± 11.5 (62–92) years. Three donors were female, and three were male. Ten k-wires were examined in BC group and 10 in the TC group. The mean bone density of the used proximal ulnas was on average 579 ± 186 (336–899) HU. The maximum pullout strength was 263 ± 106 (125–429) N in the BC group and increased significantly in the TC group to 325 ± 102 (144–466) N [p = .005]. Conclusion This study confirms for the first time biomechanical superiority of tricortical k-wire fixation in the olecranon when using a TBW and may justify the clinical use of this method.

COMPARISON OF FUNCTIONAL OUTCOME OF MODIFIED TBW VERSUS MODIFIED TBW AUGMENTED WITH CIRCUMFERENTIAL CERCLAGE WIRING IN TRANSVERSE FRACTURE OF PATELLA

2021 ◽  
pp. 47-48
Author(s):  
Satendra Kumar Sinha ◽  
Angwsa Hazowary
Keyword(s):  
Deep Infection ◽  
Tension Band ◽  
Tension Band Wiring ◽  
P Value ◽  
Complication Rates ◽  
Transverse Fracture ◽  
Group 2 ◽  
Displaced Fracture ◽  
Group 1

Background: The most common fracture of patella is transverse fracture of body. The gold standard treatment for displaced fracture is by tension band wiring (TBW) technique, augmentation with circumferential cerclage ss wiring has been suggested to improve the strength of the xation. Methods: The study was conducted at Nalanda Medical College, Patna during the period 2018-2020, by treating 28 patients. Group 1 (n=15) treated with modied tension band wiring (TBW) alone while as Group 2 (n=13) treated by modied TBW along with augmented circumferential cerclage ss wiring. Outcome was studied, graded and compared using the Modied Bostman Scale, union rates, and complication rates. Results: The results at nal follow up in group 1 were excellent in 10( 66.67%), good in 4(27.67%) and unsatisfactory in 1(6.67%). In group 2 the results were excellent in 8(61.54%), good in 5(38.46%) and no unsatisfactory results. Both groups have similar outcomes based on the scoring system used. The results were tested using t test and found to be different but not statistically signicant( p value- 0.469). In group one, 1(6.67%) developed deep infection and 1(6.67%) developed supercial infection. In group 2 2(15.38%) developed supercial infection, however these results are not statistically signicant (p value-0.432). Hardware irritation was seen in 3(20%) of group 1 and 3(23.07%) of group 2(p value>.05). 2(13.33%) of group 1 had implant removal during the course of follow up where as 2(15.38) in group 2 had hardware removal done. Conclusions: Modied tensioned band wiring for displaced transverse fracture of patella is an inexpensive and excellent method of treatment and the use of circumferential cerclage ss wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over xation with tension band wiring alone.

scholarly journals Modified two-tension-band for patellar fractures

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989349
Author(s):  
Chong Zhang ◽  
Yong Zhao ◽  
Kai Deng
Keyword(s):  
Complication Rate ◽  
Early Mobilization ◽  
Tension Band ◽  
Bony Union ◽  
Complication Rates ◽  
Lower Complication ◽  
Band Group ◽  
Group 2 ◽  
Patellar Fractures ◽  
Group 1

Objective To compare a modified two-tension-band (MTTB) technique with the AO tension band in treating patellar fractures. Methods This retrospective study included patients treated with AO tension band (group 1) or MTTB (group 2). Data obtained during serial follow-up evaluations of time to bony union, range of motion (ROM), Hospital for Special Surgery (HSS) score and complication rates, were analysed. Results Fractures healed in all 51 patients included in the study (group 1, n = 28; group 2, n = 23), with no statistically significant between-group difference in time to bony union. Regarding function results, group 2 had better HSS scores at 3 and 6 months postoperatively; however, at 1 year postoperatively, both groups had similar HSS scores and achieved acceptable flexion and ROM. The overall complication rate was significantly lower in group 2, but average costs were higher in group 2 versus group 1. Conclusion MTTB provides secure fixation and improved knee function at 3 and 6 months postoperatively, and has a lower complication rate with early mobilization, compared with the AO tension-band technique.

scholarly journals Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Kwang Won Lee ◽  
Sang Beom Ma ◽  
Dae Suk Yang ◽  
Seung Hak Oh ◽  
Seong Ho Park
Keyword(s):  
Operation Time ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Bone Union ◽  
Suture Materials ◽  
Nonabsorbable Suture ◽  
Patella Fractures ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background For treating displaced patella fractures, tension band wiring is the most widely used technique. However, implant removal surgery is often necessary to alleviate discomfort caused by fixation materials. On the contrary, fixation using nonabsorbable suture materials is anticipated to result in comparable outcomes without need for further implant removal surgery. However, there is a lack of clinical studies comparing the two fixation techniques (wire and nonabsorbable suture materials) for acute patella fractures. Methods From 2014 to 2018, we retrospectively reviewed 60 patients who underwent open reduction with internal fixation for acute patella fracture. Thirty patients (group 1) who received surgery using tension band wiring and 30 patients (group 2) who received surgery using nonabsorbable suture materials were enrolled. The average follow-up period was more than 1 year after operation. Operation time, postoperative bone union time, range of motion (ROM) of the knee joint, postoperative clinical results, and complications were compared between the two groups. Result Operation time, clinical bone union, and radiologic bone union were not statistically different between groups 1 and 2. At 3 months postoperatively, flexion was 120.3 ± 9.4° in group 1 and 110.5 ± 7.7° in group 2, showing statistically significant difference (p = 0.037). At 6 and 12 months postoperatively, the ROM was similar in both groups. Hospital for special surgery score at 3 months postoperatively was 78.4 ± 8.2 in group 1 and 83.7 ± 8.7 in group 2, showing statistically significant differences (p = 0.032). However, at 6 and 12 months postoperatively, there were no statistical differences. Lysholm score at 3 months postoperatively was 73.5 ± 8.1 in group 1 and 80.4 ± 8.2 in group 2, showing statistically significant difference (p = 0.016), but at 6 and 12 months postoperatively, there were no statistical differences. Conclusion Fixation using multiple nonabsorbable suture materials can be an alternative surgical method in managing patella fractures, along with tension band wiring.

scholarly journals Comparative study of Modified Tension Band Wiring versus Tension Band Through Parallel CannulatedCancellous Screws in Patella Fractures

2020 ◽  
Vol 4 (3) ◽  
pp. 777-781
Author(s):  
Praphulla Shrestha ◽  
Pralhad Kumar Chalise ◽  
Sujan Raj Paudel
Keyword(s):  
Soft Tissue ◽  
Complication Rate ◽  
College Teaching ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Medical College ◽  
Patella Fractures ◽  
Special Surgery ◽  
K Wires ◽  
Patellar Fractures

Introduction: Open reduction and internal fixation is indicated in patients with displaced patella fracturesand loss of the extensor apparatus.Transverse fractures of the patella are commonly treated with modified tension band wire (MTBW). Loosening of the wires along with the implant construct and soft tissue irritation by the wires had already been reported. The newer technique, tension band wiring through cannulated cancellousscrews(TBWCCS) is soft tissue friendly and gives better stability.  Objective: The objective of this study is to compare the outcome of treatment of patella fractures by modified tension band wiring with k wires and tension band wiring through parallel cannulated cancellous screws in terms of union rate, functional outcome and complication rate. Methodology: We performed acomparative study between the two procedures from September 2017 to January 2019 at Nepal Medical College Teaching Hospital. Total of 40 patients, 20 in each groupware enrolled in the study.Allthe patients were followed at regular intervals. Time taken for radiographic union was recorded. Variables of Modified Hospital for Special Surgery Knee Score (MHSSKS) were recorded and graded till the last follow-up at 24 weeks. Complications of each procedure were recorded.The data was analyzed using SPSS version 16. Results: All fractures united at 12.20±3.03 weeks in MTBWgroup and 11.20±2.78 weeks in TBWCCS group. Complication rate was significantly higher in MTBW group. In TBWCCS group, 90% patients had good to excellent MHSSKS score whilein MTBW group, 75% had good to excellent results at 24 weeks. Pain during walking was significantly better in TBWCCS group.  Conclusion: On the basis of our study, tension band wiring through cannulated cancellousscrews is an effective method of treatment of patellar fractures.

scholarly journals Comparative study of management of olecranon fractures using tension band wiring technique with cancellous screw and K wires

2016 ◽  
Vol 2 (3) ◽  
pp. 109
Author(s):  
Krishnaprasad H. S. ◽  
Shivanna Shivanna
Keyword(s):  
Comparative Study ◽  
Clinical Results ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Cancellous Screw ◽  
Medical College ◽  
Prospective Comparative Study ◽  
Group 5 ◽  
K Wires ◽  
Olecranon Fractures

<p class="abstract"><strong>Background:</strong> Olecranon fractures are commonly seen injuries in the emergency room. The surgical management of displaced fractures is open reduction and internal fixation with k-wires and figure of eight tension band wiring. It can also be fixed with intramedullary cancellous screw with tension band wiring. The present study is to compare the results of both the surgical procedures and to assess the merits and demerits.</p><p class="abstract"><strong>Methods:</strong> This prospective comparative study was carried out from August 2012 to November 2013 in Bapuji Hospital and Chigateri General Hospital attached to J.J.M Medical College, Davangere, India, where among 20 olecranon fractures, ten were treated with Tension band wiring with Kirshner wire and another ten treated with intramedullary cacellous screw with tension band wiring and the results were evaluated and compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study, most of the cases were type II B fractures according to Colton’s classification. According to Mayo elbow performance score, Excellent  results found  in 8  patients (80%), good in1patient (10%)  and fair in 1 patient (10%) in cancellous screw group and in K wire group, 5 patient (50%) had excellent, 3 patient (30%) had good  and 2 patients (20%) had fair results. No poor result was seen in both groups.</p><p><strong>Conclusions:</strong> From this study it is concluded that using cancellous screw with tension band wiring for displaced transverse and oblique olecranon fractures gives better clinical results when compared to tension band wiring with K-wire fixation avoiding cost, work time loss and possible complications from hard ware removal.</p>

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