A Randomized Comparative Study of Functional and Radiological Outcome of Tension Band Wiring for Patella Fractures...

Patellar fractures account for 1% of all skeletal injuries. Tension band wiring using SS wire has been the most commonly practiced procedure. Although this has shown good results, many patients experience hardware related problems like pain, irritation and prominence which necessitate it's removal. Recent studies have highlighted braided sutures as a possible alternative to SS wire. The purpose of this study is to evaluate the functional and radiological outcomes and complications of TBW using SS wire versus FiberWire (a reinforced braided polyblend suture) for the treatment of displaced transverse patellar fractures.

A randomized comparative study was carried out at a tertiary care center from November 2019 to May 2021. 32 patients were randomized into two equal groups, one treated with TBW using FiberWire and the other with SS wire. Patients were followed up for a period of 20 weeks and evaluated for functional outcome using the Bostman scoring scale, radiological union, complications and hardware removal rates.

The mean duration for radiological union was 12.85 weeks using FiberWire and 12.75 weeks using SS wire. The mean knee range of motion was 118.57° in the FiberWire group and 117.18° in the SS wire group. Functional scores in the FiberWire and SS wire groups were 24 (good) and 26 (good) respectively measured using the Bostman scoring scale at end of 20 weeks. Complications like hardware prominence, soft tissue irritation and hardware removal rates were significantly higher in the SS wire group with a p value of 0.023.

SS wire is biomechanically stronger than FiberWire when used for TBW. Both implants produce comparable results with respect to union rate, ROM and functional outcome, however, FiberWire causes fewer hardware complications like prominence and pain and hence alleviates the need for a second surgical procedure for implant removal. Thus, surgical treatment of transverse and inferior pole of patella fractures with TBW using FiberWire is a better alternative to SS wire considering early rehabilitation and lesser complication rates.