Management of displaced patella fracture with modified tension band wiring and percutaneous cannulated screws-a dilemma

Vishal Singh, Avinash Gundavarapu, Alokeshwar Sharma, Tejas Patel


Background: Displaced patella fracture has seen various surgical management methods in the past among which tension band wiring (TBW) and less invasive percutaneous cannulated cancellous (CC) screw  fixation are mostly preferred and debated on which is better option. The study has been designed to compare the functional outcome and various parameters of both the methods.

Methods: The study was conducted as prospective clinical study in 30 skeletally mature patients with x-ray evidence of patella fracture fulfilling inclusion and exclusion criteria, out of which 15 were done tension band wiring and rest percutaneous cancellous screw and outcome graded as excellent, good, fair and poor based on Lysholm knee score.

Results: The comparison of the mean values of the Lysholm score in patients operated with patella TBW (92.47) were better than with percutaneous CC screw fixation (88.93). Patella TBW was responsible for all the cases of infection 2 (6.67%) and delayed non-union 1 (3.33%). Whereas stiff was nearly equal in both the techniques. The comparison of the mean values of the knee flexion in patients operated by using percutaneous CC screw (107.27) was better than patella TBW (105.67).

Conclusions: Patients managed with CC screw fixation technique achieved better knee function, especially in the early postoperative period. The reported advantages of the percutaneous fixation technique include avoidance of extended incisions, preservation of the blood supply to the patella, and the possibility of a simpler removal of all hardware in the clinical setting. These results suggest that the percutaneous CC screw technique may be a superior alternative to conventional modified tension band wiring.


CC screw, Lysholm score, Patella fracture, TBW

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