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Benefits seen with cannulated screw, cable technique for transverse patella fractures
Tian Y. Clin Orthop Relat Res. 2010. doi: 10.1007/s11999-011-1913-z
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Investigators from China found that patients treated with a titanium cable-cannulated screw tension band technique for transverse patella fractures had fewer complications, faster healing times and better knee function, than those treated with a modified K-wire tension band technique.
The investigators studied 105 patients aged 22 years to 85 years between 2006 and 2009. Fifty-two patients underwent modified K-wire tension band surgeries and 49 underwent titanium cable-cannulated screw tension band surgeries. All patients were diagnosed with either transverse patella fractures or transverse patella fractures with a longitudinal fragment.
Patients in the cannulated screw and cable group experienced no complications. Five patients in the K-wire tension band group reported skin irritation from wire tails postoperatively. Eight patients experienced K-wire tension band loosening and migration. Three patients required a second operation for internal fixation loosening and fracture displacement.
Knee function scores were better for the cable-cannulated screw tension band group at an Iowa score of excellent for 45 patients compared to 36 patients for the modified tension band group.
Fractures healed faster in the titanium cable-cannulated screw tension band group at an average of 2 months compared with the modified tension band group at 2.33 months. Fracture spacing was greater in the K-wire modified tension band group at an average 0.63 mm than in the cable-cannulated screw tension band group at 0.04 mm. Postoperative interfragmentary gaps were also greater in the K-wire tension band group (2 mm in 10 patients and 3 mm in two patients) than in the titanium cable-cannulated screw tension band group (all patients, 2 mm).
This is a retrospective study that showed cannulated screws and titanium cable (49 patients) is superior to modified tension band (52 patients) in stabilization of transverse patella fractures with no comminution.
Postoperative interfragmentary gap, knee function (Iowa Knee Score) at 1 year, fracture healing time and complications rate were all significantly better with the cannulated screws and cable group (P<0.05).
The decision on surgical technique was based on whether the patient was able to pay for the cost of cannulated screws and titanium cable. Hence, there was no randomization. Twelve patients were lost to follow-up, but there is no mention as to how many were in each group.
The authors’ explanations for failure of K-wire and tension band fixation are smooth wires leading to loosening, bending the K-wires only at the proximal end and twisting wires at only one site rather than two. Also, primary compression of fracture in screws and cable method is achieved by the screws while in the modified tension band fixation compression is by tightening the tension band wires.
Overall, the authors present a good argument in favor of cannulated screw and titanium cable fixation of transverse patella fractures.
— Gunasekaran Kumar, MS Orth, FRCS (Tr&Orth)
Consultant Orthopaedic Surgeon
Royal Liverpool and Broadgreen University Hospitals
Liverpool
Disclosures: Kumar has no relevant financial disclosures.