Functional Outcome of Modified Tension band wiring in Transverse Fracture of Patella

Chaudhary R*, Joshi A*, Bajaracharya AR*


Introduction: Because of its subcutaneous location and attachment of strong muscles and ligaments the patella is eccentrically loaded and predisposed to both direct and indirect injuries. Fractures of the patella are one of the most common fractures encountered by an orthopedic surgeon. Various internal fixation techniques have been described like, circumferential wiring, tension band wiring and modified tension band wiring with K wire. Despite modified tension band wiring being most commonly performed surgery for patella fracture, there are few studies performed in our context. We suppose that modified tension band wiring will be as effective as published studies even in our country like Nepal where squatting is important in daily activities.

Method: This was prospective interventional study done in Bir hospital and Birendra Army hospital. This study consists of 30 cases of displaced transverse fracture treated by modified tension band wiring. Study consisted of patients above 19 to 55 years both male and female have been included. Patients with comminuted fractures, open Gustilo type 2 and 3 , open fractures, established knee deformity ,associated ligamentous injury and bilateral patella fractures were excluded from this study. A uniform operative and postoperative protocol was followed for each patient. They were followed up at 4thweeks, 8thweeks, 12thweeks and 24th weeks to record Reich and Rosenberg grading, pain score, range of motion and features of radiological union. The analysis was done using SPSS, for parametric data student t test was used and Chi-square test was used to analyze nonparametric data. The significance value was set as<0.005

Result: Initially 32 patients were enrolled in this study. Two patients were lost during follow up, so thirty patients were available for final analysis. The age ranged between 19 to 55 years with mean age of 35.77 years. Based on the Reich & Rosenberg criteria at the end of 24thweeks, our results were graded as excellent in 20 cases (66.7%), good in 8 (26.7%), fair in 2 (6.7%) and none had poor outcome. Similarly 28 patients (93.3%) had no pain and 2 patients (6.7%) had mild pain.

Conclusion: The functional outcome of modified tension band wiring in transverse fracture of patella in NAMS can be considered as good to excellent. Our results are comparable to the published studies. Modified tension band wiring has lesser complication rate in our study.

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