Screws vs. Solid Wires - The Better Method for Transverse Patellar Fracture Fixation - A 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