scholarly journals Screws vs. Solid Wires - The Better Method for Transverse Patellar Fracture Fixation - A Prospective Randomised Study

2021 ◽  
Vol 8 (17) ◽  
pp. 1163-1168
Author(s):  
Nagakiran K.V. ◽  
Sameer Wooly ◽  
Prasad Soraganvi ◽  
Sudeep Madhukar Nambiar ◽  
Balakrishna Gadiyar H ◽  
...  
Keyword(s):  
Tension Band ◽  
Tension Band Wiring ◽  
Definitive Treatment ◽  
Reliable Technique ◽  
Randomised Study ◽  
Significant Difference ◽  
Extensor Apparatus ◽  
Cancellous Screws ◽  
Patellar Fractures ◽  
Prospective Randomised Study

BACKGROUND Patella is a sesamoid bone that plays an important role in the extensor apparatus of the knee joint. Fractures of the patella constitute about 1 % of all fractures. Definitive treatment of the patellar fractures depends on the type of fracture, displacement, joint congruity, and intactness of the extensor apparatus. There is significant controversy about the surgical options for displaced patellar fractures. Although conventionally tension band wiring using K-wires (TBW-K wire) is a common procedure, tension band wiring using cancellous screws (TBW-CCS) is gaining popularity. A study was undertaken to compare outcomes between the two procedures (TBW-CCS & TBW-K wire). METHODS A prospective randomised study was planned. Inclusion & exclusion criteria were laid down. Institutional ethical committee clearance was obtained. 68 consenting patients with transverse patellar fractures underwent surgery (TBW-CCS or TBWK wire) after randomisation. Demographic, clinical, and radiological assessment was done. Bostman score was used as an outcome measure. Statistical analysis was done. RESULTS 85.5 % of cancellous screw group patients had excellent outcome scores as against 41.2 % in the K wire group. The difference was statistically significant. 5.8 % of patients in the cancellous group complained of implant prominence as against 17.6 % in the K wire group which was statistically significant as well. Patients in TBW-CCS had a statistically significant difference in Bostman scores at 6 weeks, 3 months, and 6 months. CONCLUSIONS Tension band wiring with cannulated cancellous screws is a safe and reliable technique in the management of transverse patellar fractures with fewer chances of implant failure and soft tissue irritation. Based on our study, tension band wiring with cannulated cancellous screws is a better method to treat transverse fractures of the patella when compared to the modified tension band wiring technique using K-wire. KEYWORDS Patella, Transverse Fracture, Tension Band Wiring, Cancellous Screws

scholarly journals Single-Step Renal Dilatation Is a Novel Technique in Percutaneous Nephrolithotomy: A Prospective Randomised Study

2020 ◽  
Vol 20 (2) ◽  
pp. 70-73
Author(s):  
Md Shariful Islam ◽  
Md Shawkat Alam ◽  
AHM Mostofa Kamal ◽  
Md Asaduzzamman ◽  
Md Ruhul Quddus
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Perioperative Complications ◽  
Single Step ◽  
Safety And Efficacy ◽  
X Ray ◽  
Randomised Study ◽  
Operative Duration ◽  
Novel Technique ◽  
Significant Difference ◽  
Prospective Randomised Study

Purpose: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in percutaneous nephrolithotomy (PCNL). Materials and Methods: In a prospective randomised study including 62 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. Results : The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P < 0.05). There were perioperative complications, according to the Clavien grading system, in 15 (25%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. Conclusion : A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.70-73

Fixation of Closed Transverse Patella Fracture with Cannulated Cancellous Screws and Anterior Tension Band Wiring- A Prospective Study

2020 ◽  
Vol 11 (4) ◽  
pp. 7985-7989
Author(s):  
Senthil Loganathan ◽  
Raghavendran B ◽  
Thiyagarajan U ◽  
Pradeep J
Keyword(s):  
Prospective Study ◽  
Steel Wire ◽  
Knee Function ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patella Fracture ◽  
Cancellous Screw ◽  
Patella Fractures ◽  
Cancellous Screws ◽  
A Prospective Study

Patella fractures accounts for 1% of all skeletal injuries.  Patella fractures usually need to be treated with accurate reduction and fixation to obtain optimal knee function. Improper reduction of the articular fragments leads to complications like arthritis and quadriceps dysfunction. Tension band wiring and pasting are commonly performed fixation methods. Tension band wiring with K-wires is associated with wire prominence and soft tissue irritation. Cannulated cancellous screw fixation of the fracture and tension band wiring through the cannulated screws avoid the complication of wire migration and breakage.   In our study, we fixed these fractures with cannulated cancellous screws and tension band. This is a prospective study done in SRMC from 2012-2017. A total of 17 Patients with transverse patella fracture are taken into a study, 4mm cannulated cancellous screws with 18 mm stainless steel wire is used for anterior tension band wiring. Extensor retinaculum closure is done for all these patients. All patients had excellent knee function, according to KSS. There was no case of implant prominence or soft issue irritation in any of these patients. One patient had extensor lag. Cannulated cancellous screw with anterior tension band wiring is a reliable, effective and reproducible technique in treating transverse patella fractures.

scholarly journals Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Elena Müller ◽  
Karl-Heinz Frosch
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Fracture Dislocation ◽  
Secondary Fracture ◽  
Patellar Fractures ◽  
Tegner Score

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.

scholarly journals A novel technique of using a miniature plate in combination with tension band wiring to treat comminuted patellar fractures

Medicine ◽  
2018 ◽  
Vol 97 (15) ◽  
pp. e0311 ◽  
Author(s):  
Song Gao ◽  
Fengtian Zhang ◽  
Tian Gao ◽  
Xuqiang Liu ◽  
Zhihong Zhang ◽  
...  
Keyword(s):  
Tension Band ◽  
Tension Band Wiring ◽  
Novel Technique ◽  
Patellar Fractures

Anterior Locking Plate Osteosynthesis of Patellar Factures – Analysis of Complications and Functional Outcome

2021 ◽  
Author(s):  
Maxi Benita Tengler ◽  
Helmut Lill ◽  
Maike Wente ◽  
Alexander Ellwein
Keyword(s):  
Functional Outcome ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Plate Fixation ◽  
Case Series ◽  
Tension Band ◽  
Tension Band Wiring ◽  
High Rate ◽  
Locking Plate Fixation ◽  
Patellar Fractures

Abstract Background Tension band wiring is the standard procedure for patellar fractures, but is associated with a high rate of implant related complications and implant failure. Tension band wiring may fail, especially with multifragmentary and comminuted fractures. Plate fixation of complex patellar fractures seems to be superior to wiring, both clinically and biomechanically. The aim of this study was to evaluate complications after locking plate fixation in patellar fractures two years after surgery and to access the functional outcome. Material and Methods As part of a prospective case series, all patients who had received locking plate fixation of a patellar fracture between April 2013 and May 2018 were clinically examined two years postoperatively and potential complications were evaluated. Results A total of 38 patients aged 19 – 87 years were included. Complications occurred in a total of five patients (13%), including one reactive prepatellar bursitis, one chronic infection and loss of reduction due to a dislocated pole fragment in three cases. The average active range of motion of the affected knee joint two years postoperatively was 133°. The Tegner activity scale score reached 3 points, the Lysholm score 95 points and the Kujala score 95 points. Conclusion With an overall relatively low complication rate and good clinical outcome, dislocated distal pole fragments are a common complication after plate fixation of patellar fractures. If preoperative diagnostic testing shows a pole fragment, a modified hook-plate can be used, with the possibility of fixing the pole fragment.

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