Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures

Abstract

It was a retrospective case–control study. The aim of this study was to explore the clinical efficacy and complication of treatment using a modified Kirschner wire tension band (MKTB) or a cannulated screw tension band (CSTB) in transverse patellar fractures.In total, 55 patients with transverse patellar fractures were retrospectively reviewed and divided into 2 groups according to the surgical technique: 29 patients were in the MKTB group and 26 patients in the CSTB group. Bǒstman's clinical grading scale, including range of movement (ROM), pain, ability to work, atrophy of quadriceps femoris, assistance in walking, effusion, giving way, and stair-climbing, was used to evaluate the clinical results. Complications including painful hardware, implant loosening or breakage, and bone nonunion were also assessed.Both groups were evaluated at the final follow-up before removing implant in the MKTB group. The Bǒstman's score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group (P < 0.05). Twelve patients in the MKTB group underwent implant removal, and the score of ROM, pain, and effusion were higher than before removing implant (P < 0.05), but there was no difference compared to the CSTB group (P > 0.05). Seventeen patients achieved excellent results, 9 had good results, and 3 reported fair results in the MKTB group; the CSTB group had excellent results in 22 patients and good results in 4 patients, showing a significant difference in the excellent rate between the 2 groups (P = 0.021). Total Bǒstman scores in the MKTB and CSTB groups (26.96 ± 4.47 and 29.42 ± 1.47, respectively) were significantly different (P = 0.01). Total scores in the MKTB group after removing implant were higher than those before removing implant (P = 0.001), and similar to those in the CSTB group (P = 0.224). Eleven patients in the MKTB group reported painful hardware, including 4 cases of implant loosening.CSTB achieves better clinical results than MKTB, meanwhile avoiding the problems of painful hardware and implant loosening. Functional limitation caused by hardware pain was commonly seen in the MKTB group, and removing implant after fracture healing improved knee function.

Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: a meta-analysis

“…Currently, the most commonly used surgical intervention for treatment of patellar fractures is open reduction and internal fixation with Kirschner wire (K-wire) tension band (KTB; modified or not) [ 2 , 4 – 7 ]. This technique has been reported to provide satisfactory reduction outcomes in 90% of patients by converting the tension forces acting on the anterior surface into compression forces at the articular surface [ 6 ].…”

“…In addition, the long-term function improvement for the knee joint may be also limited [ 10 ]. To overcome these disadvantages of KTB, several alternative approaches have been introduced, including closed reduction and fracture fixation using cannulated screws or inter-fragmentary screws (cable pin) with or without supplementary tension band wiring through the screw [ 4 , 5 , 8 , 10 – 14 ] or open fixation with ring pin [ 15 , 16 ]. Theoretically, the screws provide stronger fixation strength than Kirschner wires according to the biomechanical testing [ 17 ] and thus can protect the implants from breakage, migration, and related complications to improve the reduction and function outcomes.…”

A precise navigation device for fixation of patella fractures with modified K-wire tension band: design and application

“…Although there are new techniques such as cannulated screw tension band [11,12] system [13] and patella plate [14], the MTBW is still the most widely accepted surgical method for the treatment of patellar transverse fracture [7]. The MTBW technique is easy to operate on and economical to reduce the burden on patients, and the key of MTBW technique is to keep two k-wires parallel [8,15].…”

Cannulated Screws and Braided Polyester Tension Band as an Alternative for Fixation of Transverse Patella Fracture: A Finite Element Analysis Study

“…10,18,20,[27][28][29][30][31][32][33][34][35][36] In place of two parallel K-wires, some authors performed different interfragmentary fixations by using cancellous screws, cannulated screws or bioabsorbable cannulated screws. 9,20,25,30,[37][38][39][40][41][42][43] Several in vitro 9,39,40,43 and clinical studies proved that screw fixation yielded satisfactory outcomes, 38,41 lower painful hardware and implant loosening. 25,37,42 For the figure-of-eight loop, several authors have advocated non-metallic implants such as braided polyester.…”

“…9,20,25,30,[37][38][39][40][41][42][43] Several in vitro 9,39,40,43 and clinical studies proved that screw fixation yielded satisfactory outcomes, 38,41 lower painful hardware and implant loosening. 25,37,42 For the figure-of-eight loop, several authors have advocated non-metallic implants such as braided polyester. 18, 27, 30-32, 34-36, 43 Clinical studies revealed non-metallic implants provided desirable union rate with lower symptomatic hardware and lower rate of second surgery.…”