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

Background: The functional and radiological outcome of the union of transverse fractures of patella treated by tension band wiring (TBW) and encirclage wiring were compared according to WEST’s criteria.Methods: During three years, 44 patients with displaced transverse fracture patella were treated randomly either by TBW or encirclage with twenty-two patients in each group. Two patients in each group were lost to follow-up.Results: Results were compared based on the period of union, post-operative complications, early mobilization and recovery to pre-injury level. Fractures united at an average of 13.6 weeks with 8-12 and 10-14 weeks in TBW and the encirclage group, respectively. Results were excellent in 65%, good in 25% and poor in 10% cases in TBW group, as compared to the encirclage group with excellent in 50%, good in 30% and poor in 20% cases. In TBW group, 75% cases had a full range of motion (ROM), 15% had >120° of flexion and 10% had flexion between 90° and 120°, as compared to 50% full ROM, 30% >120° of flexion and 20% between 90° and120° flexion in the encirclage group. A case of migration of pin and another case of limitation of flexion by 25° were noticed.Conclusions: Patients treated with TBW had better results than the encirclage in the management of transverse fractures of the patella.

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Evaluation of Functional Outcome of Patients with Transverse Fracture of Patella Treated with Tension Band Wiring - A Prospective Study Conducted at Trichur, Kerala

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/506 ◽

2021 ◽

Vol 8 (30) ◽

pp. 2757-2762

Author(s):

Prakash Ponnan ◽

Manoj Murungodiyil Kunjappan

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Treatment Option ◽

Tension Band ◽

Tension Band Wiring ◽

Extensor Mechanism ◽

Transverse Fracture ◽

Early Weight Bearing ◽

Fracture Patella ◽

Study Population

BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score

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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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20215042 ◽

2021 ◽

Vol 10 (1) ◽

pp. 122

Author(s):

Pankaj Spolia ◽

Ashish Nehru ◽

Abdul Ghani ◽

Sakib Arfee

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Surgical Management ◽

Quadriceps Muscle ◽

Tension Band ◽

Tension Band Wiring ◽

Transverse Fracture ◽

Main Function ◽

Care Hospital ◽

Transverse Fractures

Background: Patella is the largest sesamoid bone in the quadriceps tendon in the body. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. There are various methods used for fixation of these fractures. Tension band wiring (TBW) works by converting tensile forces into compressive forces when movements occur at the knee joint. The aim of our study was to evaluate the clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by TBW.Methods: This was the prospective study of 22 patients aged 20 to 60 years (mean age 41.4 years) with displaced transverse fractures of patella managed by TBW.Results: The final outcome was observed at 6 months follow up. The results were comparable with the existing literature. Radiological union was achieved within 10 to 16.2 weeks, with an average of 12.4 weeks. Out of 22, (n=16, 72.7%) had excellent outcome, (n=5, 22.7%) had good functional outcome, (n=1, 4.5%) had fair outcome. Complications were observed in 6 (27.3%) patients.Conclusions: It is concluded that the surgical treatment with TBW is the best treatment in the management of displaced transverse fractures of patella.

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Best technique for fixation of displaced transverse olecranon fractures: tension band wiring or plate fixation?

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203723 ◽

2020 ◽

Vol 6 (5) ◽

pp. 1012

Author(s):

Lokesh Kumar Yogi ◽

Gagandeep Mahi ◽

C. R. Thorat ◽

Moti Janardhan Naik

Keyword(s):

Functional Outcome ◽

Large Scale ◽

Plate Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Clinical Event ◽

Dash Score ◽

Group A ◽

Group B ◽

Olecranon Fractures

Background: Fractures of olecranon are common fractures in upper limb. Tension band wiring (TBW) and plate fixation (PF) are mostly used techniques but choice is based on type of fracture and surgeon’s preference.Methods: A study assessed functional results in 28 patients that were enrolled after the clinical event of trauma has occurred. Patients were divided into two groups- Group (A) for TBW and Group (B) for PF; here gender, age and side of fracture were ignored. Post-operative functional outcome were evaluated by using the Mayo Elbow Performance (MEP) and the Disabilities of the Arm, Shoulder and Hand (DASH) score parameters.Results: Mean (SD) union time as determined by postoperative radiographs was 8.5 (1.48) weeks for group (A) and 9 (2.08) weeks for group (B). Mean (SD) MEP score at 9 months in group (A) 84.28 (7.28) and 80.71 (10.92) in group (B). Mean (SD) DASH at 9 months in group (A) 12.2 (8.8) and 11.7 (10.4) in group (B). Complications were reported in group (A) 6 patient (42.85%) out of 14 patients and in group (B) 1 patient (7.14%) out of 14 patients.Conclusions: The current study shows that there are no significant differences in functional outcome between both the study groups. Due to lesser complications, we recommend the plate fixation approach as the better choice for transverse displaced olecranon fractures. More large scale studies are required to further confirm our results.

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Partial Patellectomy for Patellar Fracture: Tension Band Wiring and Early Mobilization

Journal of Orthopaedic Trauma ◽

10.1097/00005131-199306000-00010 ◽

1993 ◽

Vol 7 (3) ◽

pp. 252-260 ◽

Cited By ~ 39

Author(s):

L K Hung ◽

S Y Lee ◽

K S Leung ◽

K M Chan ◽

Leslie A. Nicholl

Keyword(s):

Early Mobilization ◽

Tension Band ◽

Tension Band Wiring ◽

Patellar Fracture ◽

Partial Patellectomy

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Functional outcome of tension band wiring in transverse fracture of medial malleolus

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2021.v7.i1b.2466 ◽

2021 ◽

Vol 7 (1) ◽

pp. 98-103

Author(s):

R Sahaya Jose ◽

K Visnu ◽

Shaheen Hameed ◽

K Vivek

Keyword(s):

Functional Outcome ◽

Tension Band ◽

Tension Band Wiring ◽

Medial Malleolus ◽

Transverse Fracture

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191670 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1752

Author(s):

Zubair A. Lone ◽

John Mohd ◽

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

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Study of Fracture Patella with Tension Band Wiring

International Journal of Current Research and Review ◽

10.31782/ijcrr.2021.13227 ◽

2021 ◽

Vol 13 (02) ◽

pp. 95-99

Author(s):

Mahendra Gupta ◽

Manish R Shah ◽

Aditya K. Agrawal ◽

Malkesh Shah ◽

Sarvang M Desai ◽

...

Keyword(s):

Tension Band ◽

Tension Band Wiring ◽

Fracture Patella

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Comparative study of tension band wiring and pre contoured locking compression plate fixation in olecranon fractures in adults

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20211932 ◽

2021 ◽

Author(s):

Mohit Mahoviya ◽

Pradeep Choudhari ◽

Divyanshu Patel ◽

Arpit Choyal

Keyword(s):

Comparative Study ◽

Internal Fixation ◽

Plate Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Improvement Rate ◽

Articular Fractures ◽

Group A ◽

Group B ◽

Olecranon Fractures

Background: Olecranon fractures are about 10% of all proximal forearm fractures.Mostly intra articular fractures, require anatomical reduction and internal fixation for satisfactory clinical outcomes. The most commonly used techniques are still tension band wiring (TBW) and plate fixation (PF). The aim of the current study is to discuss whether TBW or PF technique of internal fixation is better in the treatment of olecranon fractures.Methods: This is a comparative study including 30 adult patients of olecranon fracture classified by Mayo classification and operated upon by tension band plating (group A) and tension band wiring (group B) at Department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All operated cases between the period of January 2018 to August 2019 with follow up of 1 year were assessed on the basis of functional outcome using Mayo elbow performance score (MEPS).Results: The MEPS, 73% of the patients in group A achieved a good to excellent results in comparison to 60% in group B. no significant differences between the two groups could be detected regarding the clinical and radiographic outcome.Conclusions: Both TBW and PF interventions had treatment benefit in OFs. The current study reveals that there are no significant differences in MEPS, improvement rate and ROM between TBW and PF for OFs. More high-quality studies are required to further confirm our results as most of the cases included in study belonged to Mayo type IIA category.

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

10.36106/8013768 ◽

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.

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Tension Band Wiring of Unstable Transverse Fractures of the Proximal and Middle Phalanges of the Hand

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.10.013 ◽

2004 ◽

Vol 29 (2) ◽

pp. 130-134 ◽

Cited By ~ 9

Author(s):

O. PEHLIVAN ◽

A. KIRAL ◽

C. SOLAKOGLU ◽

I. AKMAZ ◽

H. KAPLAN

Keyword(s):

Functional Outcomes ◽

Tension Band ◽

Tension Band Wiring ◽

Fracture Line ◽

Kirschner Wires ◽

Shaft Fractures ◽

Transverse Fractures

Twenty-three isolated, unstable and closed transverse middle and proximal phalangeal shaft fractures in 23 patients were treated by tension band wiring. The tension band was applied with two transverse Kirschner wires that did not cross the fracture line. All of the fractures united and achieved satisfactory functional outcomes. No patient required either physiotherapy or tenolysis or capsulotomy surgery.

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