Abstract
Background: Patellar fractures constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma. Patella is of importance for the extension of knee joint, which increases the force of quadriceps apparatus by improving the leverage, in addition it protects the anterior surface of distal femur against external violence but may be easily injured due to unprotected position. Any compromise of the joint surface is likely to lead to degenerative joint disease. It is therefore, highly desirable, in patellar fractures to strive for anatomical reduction of the joint surface and stable fixation.
Objectives: To determine the demographic profile (age and sex distribution) of our patients with fracture patella.
To study the functional outcome by early mobilization.
To study the complications of tension band wiring.
To clinically evaluate the tension band wiring technique for fracture patella.
To assess knee joint motion and stability after the procedure.
To study the mode of injury for fracture patella.
Methods: This prospective study is consists of 40 selected cases of fractured patella treated by modified tension band wiring at the Kakatiya Medical College, MGMH, Warangal from July 2015 to October 2017.
Results: 40 cases of fracture patella treated by tension band wiring technique at Kakatiya Medical College, MGM Hospital, Warangal. have been presented. Maximum number of cases 11 (27.5%) were in the age group of 41-50.There was male sex predomination, 29(62.5%) were males and 11(27.5%) were females. Right side fractures were common with 25(62.5%) cases. 31(77.5%) cases are due to an indirect trauma to the knee joint, direct injury resulted fracture patella in 9(22.5%) cases. 26(65%) cases are transverse fractures and 14 (35%) cases had comminuted fractures. Subjective complaints like mild pain was observed in 6(15%) patients and moderate pain was observed in 2(5%) patients.
8(20%) patients had flexion limitation, quadriceps wasting was observed in 8(20%) patients a quadriceps power of grade-4 was observed in 8 (20%) patients. Extensor lag of 5 to 10 degrees was seen in 2 cases(5%), 32 (80%) cases had excellent result, 6 (15%) cases had good results and 2(5%) cases had poor results based on WEST"S CRITERIA following modified tension band wiring procedure.
Keywords: Patella, Fractures, Treatment, Tension band Wiring.
References
- Matthew I. Rudloff "Campbell's operative orthopaedics". Chapter 54. 12th edition, S. Terry Canale, James H.Beaty, Elsevier Mosby, Vol. 3, 2013: 2681-2688pp.
- Haxton A. "The functions of the patella and the effects of its excision". Surg Gynaec Obst, 1945; 80: 389pp.
- Kaufer "Mechanical function of the patella". JBJS, 1971; 53 (A): 1551.
- Cameron HC. "Transverse fracture of the patella". Glasgow Med J, 1878; 10: 289-294pp.
- Douglas , Netto. "Fractures of the Patella". PGMJ, 1963; 39: 83.
- Muller ME, Aiigower M, Willinegger H. "Technique recommended by the AO group. In: Manual of internal fixation". New York: Sphringer-Verlag, 1979; 249-250pp.
- Weber M.J., Janecki C.J., McLeod P. et al. "Efficacy of various forms of fixation of transverse fractures of the patella". JBJS, Am, March 1980; 62 (2):
- Dudani B, Sancheti K.M. "Management of fracture patella by tension band wiring". J of Ortho. 1981; 15-1: 43-48pp.
- Benjamin J, Bried J, Dohmm et al. "Biomechanical evaluation of various forms of fixation of transverse patellar fracture". J Ortho Trauma, 1987; 1: 219pp.
- Curtis J. "Internal fixation for fractures of the patella. A comparison of two methods". JBJS Br, March 1990; 72 (2):
- Carpenter JE, Kasman RA, Patel N. et al. "Biomechanical evaluation of current patella fracture fixation techniques". J Orthop Trauma, 1997; 11: 351- 356.
- Gray's Anatomy, 40th edition, Churchill Livingstone, 2008, ch 82: 1393-1410pp.
- Cunningham's manual of practical anatomy, 15th edition, ELBS, Oxford University Press, 1, 1984: 215-221 pp.
- Scapinelli R. "Blood supply of the human patella". JBJS, 1967; 49 (B): 563- 570pp.
- Fredrick J. Liee. "Quadriceps mechanism of the knee" JBJS, 1966; Vol. 48 (6):51-54.
- Grooves W. Hey. "A note on the extension apparatus of the knee joint". Br.J Surg, 1937; 24: 747-748pp.
- Asheesh Bedi & Madhav.A.Karunakar. "Rockwood and Green's Fractures in adults", Charles A. Rockwood, Robert W. Bucholz (edt) ,Chapter 52, 7th edit-ion, Philadelphia, Lippincott Williams& Wilkins, Vol. 2, 2010: 1752- 1779pp.
- Desai N. "A study of different types of treatment in fractures of the patella". Ind J Surg, 1972; 34: 54.
- Bostrom A. "Fractures of the patella: A study of 422 patellar fractures". Acta ortho 1972; 143:1-80pp.
- Logan "Conservative treatment for comminuted fracture of the patella". JBJS, 1969; 51 (B): 776pp.
- Levack B, Flannagan P., Hobbs S. “Results of surgical treatment of patellar fractures". JBJS, 1985; 67-B: 416-419pp.
- Timothy J Bray et al. chapter 46 in Michael W Chapmans Operative Orthopaedics, 2nd edition, Philadelphia, JB Lippincott Company, 1, 1993: 663-670pp.
- Gardner, Michael J, Griffith, Matthew H, Lawrence, Brandon D, Lorich, Complete exposure of articular surface for fixation of patellar fractures. J orthop trauma 2005 feb;19(2):118-123.
- Szyskowitz Muller ME et al. chapter 13 in manual of internal fixation. Technique recommended by the AO group, 3rd edition, New York, Springer Verlag, 1992, 226-227, 564-569pp.
- Chrioff B.T. "A new technique for the treatment of comminuted transverse fractures of the patella". Gynaec Obst, 1977:145pp.
- DePalm F Flynn JJ "Joint changes following partial and total patellectomy" JBJS, 1958; 40a: 395.
- Basu Ray K. and Ghosh M.S. "Functional end results of patellectomy in fracture of the patella". Ind J Orthop, Vol. 8; 1974.
- Bostman O, Kivilvoto O, Nirhamo J, "Comminuted displaced fracture of patella". Injury, 1982; 13: 196-202pp.
- Siddaram N. Patil, Sankar Rao P. A Prospective Clinical Study of Patellar Fractures Treated by Modified Tension Band Wiring. Open Science Journal of Clinical Medicine. Vol. 2, No. 2, 2014, pp. 54-58.
- Sudheendra P. R, Krishnaprasad S. “Functional Outcome of Patellar Fractures Treated by Internal Fixation: A Retrospective Study”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 29
- Anand Jabshetty B. A comparative study of modified tension band wiring and cerclage wiring in management of transverse fractures of Indian Journal of Science and Technology. 2011; 4:0974-6846.
Corresponding Author
L.G. Vishali
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9885550890