The Outcomes of Cannulated Screws Versus Tension Band Wiring in Treatment of Transverse Patellar Fracture: A Comparative Study

Authors

  • Ahmed S. Mazyon Department of Orthopedic Surgery, College of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq https://orcid.org/0000-0002-5371-2875
  • Mohammed Jaffer Jawad Department of Orthopedic Surgery, College of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq
  • AKS Diab Department of Orthopedic Surgery, College of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq

DOI:

https://doi.org/10.3889/oamjms.2023.9848

Keywords:

Patella, fracture, Cannulated screw, Tension band, Wiring, Iraq

Abstract

BACKGROUND: For the treatment of displaced patella fractures by tension bands with cannulated screws and by K-wire are widely employed. The clinical efficacy of the two therapy regimens, however, remains a point of contention.

AIM: The study goal was to assess the relative advantages and drawbacks of open reduction and internal fixation using tension band wiring versus cannulated screws with wiring in patients sustained displaced patellar fracture.

PATIENTS AND METHODS: A clinical trial study conducted in the Orthopedics Department at Al-Yarmook Teaching Hospital during a period of 18 months from June 2020 to November 2021. It included 22 adult patients diagnosed with isolated displaced transverse patellar fracture and scheduled for operative fixation. They were divided randomly into two groups: Tension band technique group (TBT) included 11 patients underwent open reduction internal fixation (ORIF) with TBT and cannulated screws (CS) group included 11 patients underwent ORIF by cannulated screws with wiring. A postoperatively follow-up was continued for 6 months. In which patients were assessed clinically and radiographically 4 time, at the end of the 1st, 2nd, 3rd, and 6th months.

RESULTS: After 1, 2, and 3 months, means of Lysholm score and range of flexion were significantly higher; while mean of VAS score of pain was significantly lower in CS group than that in TBT group. No statistical significant differences in postoperative complications were found between study groups.

CONCLUSION: Tension band wire with cannulated screws is the most effective surgical approach for internally repairing transverse fractures of the patella which allows for an early start to postoperative functional activity and an improved quality of life.

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References

Bryant TL, Anderson CL, Stevens CG, Conrad BP, Vincent HK, Sadasivan KK. Comparison of cannulated screws with fiberwire or stainless steel wire for patella fracture fixation: A pilot study. J Orthop. 2014;12(2):92-6. https://doi.org/10.1016/j.jor.2014.04.011 PMid:25972700 DOI: https://doi.org/10.1016/j.jor.2014.04.011

Gwinner C, Märdian S, Schwabe P, Schaser KD, Krapohl BD, Jung TM. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc01. https://doi.org/10.3205/iprs000080 PMid:26816667

Desai TV, Moradiya NP. Management of communited patellar fracture with combined tension band wiring technique and encirclage. Int J Res Orthop. 2018;5(1):104. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20185330

Eyal S, Blitz E, Shwartz Y, Akiyama H, Schweitzer R, Zelzer E. On the development of the patella. Development.

;142(10):1831-9. https://doi.org/10.1242/dev.121970 PMid:25926361 DOI: https://doi.org/10.1242/dev.121970

Helfet DL, Haas NP, Schatzker J, Matter P, Moser R, Hanson B.AO philosophy and principles of fracture management-its evolution and evaluation. J Bone Joint Surg Am. 2003;85(6):1156-60. https://doi.org/10.2106/00004623-200306000-00029 PMid:12784017 DOI: https://doi.org/10.2106/00004623-200306000-00029

Wardak MI, Siawash AR, Hayda R. Fixation of patella fractures with a minimally invasive tensioned wire method: Compressive external fixation. J Trauma Acute Care Surg. 2012;72(5):1393-8. https://doi.org/10.1097/TA.0b013e318248b7cf PMid:22673272 DOI: https://doi.org/10.1097/TA.0b013e318248b7cf

LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma. 2012;26(7):422-6. https://doi.org/10.1097/BOT.0b013e318228c1a1 PMid:22183197 DOI: https://doi.org/10.1097/BOT.0b013e318228c1a1

Mao N, Liu D, Ni H, Tang H, Zhang Q. Comparison of the cable pin system with conventional open surgery for transverse patella fractures. Clin Orthop Rel Res. 2013;471(7):2361-6. https://doi.org/10.1007/s11999-013-2932-8 PMid:23529632 DOI: https://doi.org/10.1007/s11999-013-2932-8

Thelen S, Schneppendahl J, Jopen E, Eichler C, Koebke J, Schönau E, et al. Biomechanical cadaver testing of a fixed- angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury. 2012;43(8):1290-5. https://doi.org/10.1016/j.injury.2012.04.020 PMid:22608600 DOI: https://doi.org/10.1016/j.injury.2012.04.020

Wu C, Tai C, Chen W. Patellar tension band wiring: A revised technique. Arch Orthop Trauma Surg. 2001;121(1):12-6. https://doi.org/10.1007/s004020000183 PMid:11195111 DOI: https://doi.org/10.1007/s004020000183

Luo TD, Marino DV, Pilson H. Patella fractures. 2018. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022.

Zderic I, Stoffel K, Sommer C, Höntzsch D, Gueorguiev B. Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury. 2017;48(8):1749-57. https://doi.org/10.1016/j.injury.2017.05.037 PMid:28622833 DOI: https://doi.org/10.1016/j.injury.2017.05.037

Ling M, Zhan S, Jiang D, Hu H, Zhang C. Where should Kirschner wires be placed when fixing patella fracture with modified tension-band wiring? A finite element analysis. J Orthop Surg Res. 2019;14(1):14. https://doi.org/10.1186/s13018-019-1060-x PMid:30634995 DOI: https://doi.org/10.1186/s13018-019-1060-x

Mao N, Ni H, Ding W, Zhu X, Bai Y, Wang C, et al. Surgical treatment of transverse patella fractures by the cable pin system with a minimally invasive technique. J Trauma Acute Care Surg. 2012;72(4):1056-61. https://doi.org/10.1097/TA.0b013e318240d728. PMid:22491627 DOI: https://doi.org/10.1097/TA.0b013e318240d728

Rathi A, Swamy MK, Prasantha I, Consul A, Bansal A, Bahl V. Percutaneous tension band wiring for patellar fractures. J Orthop Surg (Hong Kong). 2012;20(2):166-9. https://doi.org/10.1177/23094990120200020 PMid:22933672 DOI: https://doi.org/10.1177/230949901202000206

Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet Disord. 2015;16:282. https://doi.org/10.1186/s12891-015-0719-7 PMid:26445425 DOI: https://doi.org/10.1186/s12891-015-0719-7

Fox AJ, Wanivenhaus F, Rodeo SA. The basic science of the patella: Structure, composition, and function. J Knee Surg. 2012;25(2):127-42. https://doi.org/10.1055/s-0032-1313741 PMid:22928430 DOI: https://doi.org/10.1055/s-0032-1313741

Arroyo-Morales M, Martin-Alguacil J, Lozano-Lozano M, Cuesta-Vargas AI, Fernández-Fernández AJ, González JA, et al. The lysholm score: Cross cultural validation and evaluation of psychometric properties of the Spanish version. PLoS One. 2019;14(8):e0221376. https://doi.org10.1371/journal. pone.0221376 PMid:31454386 DOI: https://doi.org/10.1371/journal.pone.0221376

Liu C, Ren H, Wan C, Ma J. Comparison of the therapeutic effects of tension band with cannulated screw and tension band with kirschner wire on patella fracture. Comput Math Methods Med. 2020;2020:4065978. https://doi.org/10.1155/2020/4065978 PMid:32908578 DOI: https://doi.org/10.1155/2020/4065978

Zhang Y, Xu Z, Zhong W, Liu F, Tang J. Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis. J Orthop Surg Res. 2018;13(1):1-10. https://doi.org/10.1186/s13018-018-0919-6 DOI: https://doi.org/10.1186/s13018-018-0919-6

Gick S, Dargel J, Wissussek B, Koebke J, Pennig D, editors. Comparison of Tension Band and Interfragmentary Screw Fixation with a New Implant in Transverse Patella Fractures a Biomechanical Investigation. Orthopaedic Proceedings. London: The British Editorial Society of Bone and Joint Surgery; 2011. https://doi.org/10.1016/j.injury.2009.07.007

Tan H, Dai P, Yuan Y. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures: A strobe-compliant retrospective observational study. Medicine (Baltimore). 2016;95(40):e4992. https://doi.org/10.1097/MD.0000000000004992 PMid:27749556 DOI: https://doi.org/10.1097/MD.0000000000004992

Shrestha P, Chalise PK, Paudel SR. Comparative study of modified tension band wiring versus tension band through parallel cannulatedcancellous screws in patella fractures. Birat J Health Sci. 2019;4(3):777-81. https://doi.org/10.3126/bjhs.v4i3.27012 DOI: https://doi.org/10.3126/bjhs.v4i3.27012

Dargel J, Gick S, Mader K, Koebke J, Pennig D. Biomechanical comparison of tension band-and interfragmentary screw fixation with a new implant in transverse patella fractures. Injury. 2010;41(2):156-60. https://doi.org/10.1016/j.injury.2009.07.007 PMid:19665707 DOI: https://doi.org/10.1016/j.injury.2009.07.007

Tian Y, Zhou F, Ji H, Zhang Z, Guo Y. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures. Clin Orthop Rel Res. 2011;469(12):3429-35. https://doi.org/10.1007/s11999-011-1913-z PMid:21573937 DOI: https://doi.org/10.1007/s11999-011-1913-z

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Published

2023-01-03

How to Cite

1.
Mazyon AS, Jawad MJ, Diab A. The Outcomes of Cannulated Screws Versus Tension Band Wiring in Treatment of Transverse Patellar Fracture: A Comparative Study. Open Access Maced J Med Sci [Internet]. 2023 Jan. 3 [cited 2024 Nov. 21];11(B):550-4. Available from: https://oamjms.eu/index.php/mjms/article/view/9848