Functional outcome of minimally invasive modified tension band wiring in transverse fracture of patella fracture

Abstract

Background: Patella fractures are one of the most common types encountered by an orthopedic surgeon. It continues to pose problems being intra articular, and subjected to continuous deforming forces from muscles. It is also difficult to restore the desired anatomical continuity and congruity of the articular surfaces after reduction and thereby causing complications like osteoarthritis, stiffness of joints, non-union. Hence, this study is aimed to assess the functional outcome of minimally invasive modified tension band wiring in transverse patella fracture.

Methods: This was a prospective observational study, done at a tertiary care hospital. This study included adult patients in the age group 18 to 60 years, with displaced transverse fracture of patella treated by minimally invasive modified tension band wiring. Patients with comminuted fractures, open fractures, established knee deformity, and associated ligamentous injury were excluded from this study. They were followed up at 2^nd, 4^th , 8^th , 12^th  and 24^th  weeks post-operatively to record Reich and Rosenberg grading, pain score, range of motion and features of radiological union.

Results: Total of 30 patients were enrolled in this study. The incidence was high in the age group of 31-40 years.  The mechanism of injury was indirect in 21 cases and direct in 9 cases. Majority of patients 28 (93.3%) had their clinical union in less than 8 weeks and only one (3.3%) had complication with superficial wound infection. Based on the Reich and Rosenberg criteria for movement at the end of 24th weeks, our results were graded as excellent in 16 cases (53.3%), good in 8(46.7%) cases, and none had fair or poor outcome. Similarly, mean pain score at 2^nd, 4^th,  8^th , 12^th  and 24^th  weeks of follow up  is 3.04±0.54,  2.1±0.56, 0.87±0.27, 0.49±0.18 and 0.14±0.1, respectively. Mean range of motion at 2^nd,4^th , 8^th , 12^th  and 24^th  weeks of follow ups are 65.83±7.08, 83.66 ± 9.6, 133.83 ±.64, 135.83±5.03 and 137.33±3.13 degrees, respectively with significant improvement in range of motion. A total of 93.3% (28) of patients had radiological union before 8 weeks and 6.66% (2) patients had radiological union after 8 weeks.

Conclusion: Fixation of transverse patella fracture with modified tension band wiring gives good union within 2 months with low complication rates.