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      Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures

      research-article
      Author(s): , MD , , MD, , MD, , MD, , MD
      Publication date (Electronic):
      Journal: Clinical Orthopaedics and Related Research
      Publisher: Springer-Verlag

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          Abstract

          Background

          Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation.

          Questions/purposes

          We conducted a retrospective comparison of the modified tension band technique and the titanium cable-cannulated screw tension band technique.

          Patients and Methods

          We retrospectively reviewed 101 patients aged 22 to 85 years (mean, 56.6 years) with AO/OTA 34-C1 fractures (n = 68) and 34-C2 fractures (n = 33). Fifty-two patients were in the modified tension band group and 49 were in the titanium cable-cannulated screw tension band group. Followup was at least 1 year (range, 1–3 years). Comparison criteria were fracture reduction, fracture healing time, and the Iowa score for knee function.

          Results

          The titanium cable-cannulated screw tension band group showed improved fracture reduction, reduced healing time, and better Iowa score, compared with the modified tension band group. In the modified tension band group, eight patients experienced wire migration, three of these requiring a second operation. There were no complications in the titanium cable-cannulated screw tension band group.

          Conclusions

          The titanium cable-cannulated screw tension band technique showed superior results and should be considered as an alternative method for treatment of transverse patellar fractures.

          Level of Evidence

          Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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          Most cited references14

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          Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

          J L Marsh, Theddy Slongo, Julie Agel … (2008)
          The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.
          Article 0 comments Cited 343 times – based on 0 reviews     Review now
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            Early complications in the operative treatment of patella fractures.

            Avilash Cramer, I. Watson, H Karges … (1997)
            To identify and review early complications in the operative treatment of patella fractures. Retrospective review. Single tertiary care institution with multiple surgeons, including generalists and fellowship trained subspecialists. A consecutive series of eighty-seven patella fractures over a five year period was reviewed. Patients treated nonoperatively or with partial or total patellectomy were excluded. Minimum follow-up to fracture healing (four months) was available in fifty-one fractures. Modified tension band wire fixation was used in forty-nine fractures, whereas two fractures were treated with tension band wires threaded through cannulated screws. Early complications such as loss of reduction or fixation, infection, or soft-tissue problems were evaluated. Displacement of > or = 2 mm before healing was noted in eleven fractures. The displacement could be attributed to technical errors in five cases, and to patient noncompliance with postoperative activity restrictions in another five cases. Two cases of superficial infection were documented. Nine patients with symptomatic hardware required hardware removal. Twenty-two percent of fractures treated with tension band wiring and early motion displaced > or = 2 mm within the early postoperative period. Technical errors or patient noncompliance were identified as factors. The incidence of early complications in operatively treated patella fractures is higher than previously reported.
            Article 0 comments Cited 55 times – based on 0 reviews     Review now
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              Biomechanical evaluation of current patella fracture fixation techniques.

              Karla Carpenter, N. D. Patel, Roger S. Goldstein … (1997)
              To compare the mechanical effectiveness of three different techniques for stabilization of transverse fractures of the patella. Cadaveric knees were used to model acute fractures of the patella. To test three treatment techniques in pairs of knees, specimen pairs were assigned randomly to a set of predetermined treatment pairs so as to provide equal numbers of paired and unpaired data sets. Results then were analyzed using a two-way analysis of variance. The treatment techniques used are widely applicable in the clinical setting for the treatment of transverse fractures of the patella. No specialized equipment or training is required for the general or subspecialized orthopaedic surgeon. None. Fractures were created in eighteen knees (nine pairs) and repaired by one of three techniques: (a) modified tension band (AO technique); (b) two parallel 4.5-millimeter interfragmentary lag screws; or (c) a new technique using four-millimeter cannulated lag screws with a tension band wired through the screws. In mechanical testing, the amount of interfragmentary separation in simulated knee extension and the maximum load to failure at 45 degrees of flexion were measured. Fractures stabilized with a modified tension band were found to displace significantly more than those fixed with screws alone or screws plus a tension band in simulated knee extensions (p < 0.05). The fractures fixed with the cannulated screws plus the tension band failed at higher loads (mean = 732 newtons) than those stabilized with screws alone (mean = 554 newtons, p = 0.06) or those with a modified tension band (mean = 395 newtons, p < 0.05). Combining interfragmentary screw fixation with the tension band principle appears to provide improved stability over the modified tension band or screws alone for transverse patella fractures. Cannulated screws allow for simple, reliable addition of a tension band to screw fixation.
              Article 0 comments Cited 52 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : tianyunbj@sina.com
                Journal
                Journal ID (nlm-ta): Clin Orthop Relat Res
                Title: Clinical Orthopaedics and Related Research
                Publisher: Springer-Verlag (New York )
                ISSN (Print): 0009-921X
                ISSN (Electronic): 1528-1132
                Publication date (Electronic): 15 May 2011
                Publication date PMC-release: 15 May 2011
                Publication date (Print): December 2011
                Volume: 469
                Issue: 12
                Pages: 3429-3435
                Affiliations
                Department of Orthopaedics, Third Hospital of Peking University, Beijing, 100191 China
                Article
                Publisher ID: 1913
                DOI: 10.1007/s11999-011-1913-z
                PMC ID: 3210283
                PubMed ID: 21573937
                SO-VID: 9ba42d5c-cb6e-4325-b9af-5ad23b5f5004
                Copyright © © The Author(s) 2011
                History
                Date received : 8 November 2010
                Date accepted : 29 April 2011
                Categories
                Subject: Clinical Research
                Custom metadata
                issue-copyright-statement © The Association of Bone and Joint Surgeons® 2011

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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