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

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.

Outcome of Transverse Patella Fractures Fixed With Cannulated Screws and Stainless Steel Tension Band Wiring

Background: Tension band supplemented by K-wires has long been the definitive technique for patellar fractures fixation. However, it is not without drawbacks. The stainless streel cable-cannulated screw tension band technique, may shorten healing time, decrease the complications and provide early range of knee motion. Herein, the current study evaluates the clinical and radiological outcome of this surgical modality. Methods: This prospective study was conducted on 21 patients (13 males and 8 females) with transverse fracture patella from June 2017 to April 2021. The surgical fixation consisted of two 4.0-mm parallel partially threaded cannulated cancellous screws with a figure-of-eight stainless steel tension band wiring. Follow-up was at least 10 months. Assessment criteria included the Lysholm score for knee function, ROM, VAS for pain, fracture reduction, fracture healing time, and complication rates. After 3 postoperative weeks, slab was removed and immediate rehabilitation were commenced.Results: The average Lysholm scores were 82.9 ± 4.4 SD, 87.8 ± 5.3 SD, and 92.7 ± 3.6 SD after 3, 6, and 10 months, respectively. VAS scores for pain were 2.6 ± 3.0 SD, 1.4 ± 2.6 SD, and 0.5 ± 2.3 SD at 3, 6 and 10-month, respectively. The patients had gained total ROM after 3, 6 and 10 months. The mean fracture healing time was 2.1 months (range, 1.5 - 3.1 months). Two patients experienced skin irritation by wire tails.Conclusion: The stainless steel cannulated screws and tension band construct provides a good alternative in treatment of transverse patellar fractures. It could yield stable fixation, low complication rate while providing early mobilization and accelerated rehabilitation.

Clinico-radiological and functional outcome of Mayo type IIA olecranon fractures managed with tension band wiring in a tertiary care centre in North India

<p class="abstract"><strong>Background: </strong>Tension band wiring is the most common operative technique for the internal fixation of olecranon fractures. Stable internal fixation with figure of eight tension band wiring used for simple transverse fractures allows early range of motion, minimize stiffness and gives good results. The aim of this study is to evaluate the functional outcome of simple transverse fractures managed by tension band wiring.</p><p class="abstract"><strong>Methods:</strong> This was an observational prospective study of 24 patients with Mayo type IIA fractures aged between 18 to 65 years, with mean age of 42.5 years treated by tension band wiring. Functional outcome was assessed with Mayo Elbow Performance Score (MEPS) and Visual Analogue Scale (VAS) subjective pain score.</p><p class="abstract"><strong>Results: </strong>Our study was conducted on 24 patients with Mayo type IIA, out of which 16 were males and 8 were females. Most common mode of injury was fall from standing height (75%), followed by road traffic accident (16.7%) and assault (8.3%). The age range was between 18 to 65 years, with mean age of 42.5 years.</p><p class="abstract"><strong>Conclusions:</strong> Tension band wiring is an effective method for the treatment of transverse, non-comminuted and unstable fractures of the olecranon which provides stable fixation, early rehabilitation and gives excellent results when done in expert hands.</p>