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

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

Functional outcome of surgical management in cases of fracture patella in a tertiary care hospital in Salem

<p><strong>Background: </strong>Fractures of the patella are serious injuries with a broad range of subtypes. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 20-50 years. The underlying mechanisms of open fractures are mostly high-velocity accidents. To assess the functional outcome of various surgical procedures done for fracture patella.</p><p><strong>Methods: </strong>A longitudinal study was conducted from the department of orthopedics, Vinayaka missions Kirupananda Variyar medical college and hospital, Salem for one year in August 2019 and July 2020. All the adult patients admitted with the diagnosis of patellar fracture were included in the study. A complete local examination was conducted and an X-ray of AP and the lateral view was taken for all the patients.</p><p><strong>Results: </strong>Transverse patella fracture is being the most common fracture and for that modified tension band wiring (TBW) was the most common procedure performed and for comminuted fracture partial patellectomy was the most common procedure and for 1 patient total patellectomy was performed.</p><p><strong>Conclusions:</strong><strong> </strong>The study shows that the treatment of patella fractures with modified tension band wiring is a definitive treatment with minimal complications and excellent functional outcomes.</p>

Neglected Isolated Sleeve Fracture of the Superior Pole of the Patella in a Healthy Adult – A Case Report and Review of Literature

Introduction: Sleeve fracture (SF) represents an unusual type of patellar fracture and has been reported mainly in children or adolescents. Superior pole fracture in adults is a very rare occurrence because the enthesis of the adult patella is more resilient to avulsion injury as compared to an immature pediatric skeleton. Due to the rarity of these fractures in adults and vague radiographic findings, the chances of missing the fracture are very high. Case Report: An 18-year-old boy presented to our outpatient department with a history of fall while trying to jump across a wall 6 months ago. At the time of presentation, the patient mainly complained of loss of active extension of the knee in the sitting position and a palpable gap over the upper part of the patella. After radiographic evaluation, a diagnosis of SF was made. The patient was managed surgically, and thereafter, early rehabilitation was done. After 10 weeks post-surgery, the patient was free from any pain, had a full range of motion, and was able to walk without support. Conclusion: Adults presenting with acute injury to knee with limitation of extension and palpable gap over the superior pole of the patella, a differential diagnosis of SF must be suspected and should be ruled out by clinical examination and relevant investigations. Keywords: Sleeve fracture, patella, superior pole, adult.

The “invisible” wiring technique for displaced fracture patella

Background: Operative treatment of displaced patella fracture dates back to Lister in 1877. Nowadays, steel wires remain the material of choice in tension band technique despite complications such as wire breakage, suboptimal placement, or skin impingement. We propose using a high-tensile strength braided tape-shaped polyblend suture (FiberTape®, Arthrex, Naples, Florida, USA) as an alternative that could minimize complications related to steel wires. Method: Between February 2014 and April 2018, 15 patients with displaced patella fractures (three distal pole, five transverse, and seven comminuted fractures) underwent our proposed method. Open fracture reduction was performed to optimize anatomy before figure-of-eight fixation with FiberTape®. An Ethibond-2 suture was also added as cerclage for stability. Postoperatively, an extension brace was given for wound resting, before progressing to mobilization exercises with a hinge-knee brace. At follow-ups, the knee’s range-of-motion (ROM), along with bone healing status from radiographs, was assessed. Results: The mean operation time was 84.5 min, and all surgeries were performed or supervised by the same senior surgeon. Eight patients were discharged from follow-up (mean follow-up of 9.9 months) after achieving good ROM and fracture healing. One patient defaulted, and the remaining is still being followed-up. There was no wound complication or knot impingement in all cases. One patient required manipulation under anesthesia due to stiffness, and one experienced malunion due to poor compliance to rehabilitation protocol. Conclusion: Fixation using a high-tensile strength braided suture may be an equally effective method in the management of displaced patella fracture. However, larger sample size is useful to provide a more definitive conclusion.

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.