Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws

Abstract

Objective: To present the treatment outcome for patients with displaced inferior pole patella fractures treated with anterior tension band wiring through cannulated screws.

Design: Case series.

Setting: Academic Level I trauma center.

Patients/participants: During a 2-year period between January 2007 and December 2008, 10 consecutive patients (mean age, 59.8 years) with distal pole fractures of the patella (Orthopaedic Trauma Association 45.A.1) were prospectively enrolled in this study.

Intervention: All 10 patients underwent vertical skin exposure, fracture open reduction, and internal fixation by anterior tension band wiring through 4.0-mm cannulated screws.

Main outcome measurements: The range of motion, loss of fracture reduction, implant migration, material failure, soft tissue irritation, and Bostman score and Short Musculoskeletal Functional Assessment dysfunction score were primary outcome measures.

Results: There were three single-fragment fractures and seven comminuted fractures. With 1-year follow-up, all fractures healed clinically in an average of 8 weeks and radiographically on average by 12 weeks. The average range of knee motion arc was 122.5° (range, 95°-140°). Five patients have an average flexion lag of 17° (range, 10°-30°). No patient had loss of fracture reduction, implant migration, material failure, or soft tissue irritation. The average Bostman score was 28.7 out of 30 (range, 27-30), and average Short Musculoskeletal Functional Assessment dysfunction score was 24.1 out of 100 (range, 15-39). All 10 patients stated they were highly satisfied.

Conclusion: Anterior tension band wiring through cannulated screws for displaced inferior pole patella fractures is a safe, simple, and reliable alternative treatment with minimal soft tissue irritation. Good functional results and recovery can be expected.