Kumaran Chettiar1, Muhammed Rafi M2
Various treatment modalities are described for the treatment of displaced transverse fractures of patella. As patella is very important biomechanically, open reduction and internal fixation with maximal preservation of patella is the standard treatment. Most commonly used method is modified tension band wiring with Kirschner wires. In a modification, cannulated screws are used instead of K wires and wire is passed through the cannulation of the screw and anterior surface of the patella.
The aim of our study was to compare the complications and functional outcomes after surgical treatment of patellar fractures using modified tension band wiring with Kirschner wires and with cannulated screws.
MATERIALS AND METHODS
This study was conducted in Department of Orthopaedics, Government Medical College, Kozhikode, during the period 2014-2015. Total sample size was 36. They were randomised into two groups. Among them, 17 had undergone tension band wiring with cannulated screws and 19 with Kirschner wires. They were evaluated in postoperative period at 1 month, 3 months and 6 months by looking for complications like postoperative infection, postoperative loss of reduction, skin irritation by prominent hardware. Functional outcome was assessed by knee pain score and Good Fellows grading of range of motion.
According to this study while comparing these two surgical techniques, there are no statistically significant differences in terms of complications and functional outcome. We observed that cannulated screw with tension band wiring has better patient tolerance, less complications like skin irritation by prominent hardware, loss of fixation and knee pain. We found that tension band wiring through cannulated screws is technically more difficult than using Kirschner wires.
Although, the statistical analysis showed no significant differences regarding the union and final outcome, cannulated screw with tension band wiring has better patient tolerance, less complications like prominent hardware, loss of fixation and knee pain. So, tension band wiring through cannulated screws for displaced transverse fractures is safe and effective alternative treatment with fewer complications and better functional outcome.