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. 2025 Aug 25;17(8):e90918.
doi: 10.7759/cureus.90918. eCollection 2025 Aug.

Tension Band Fixation for Displaced Transverse Patella Fractures Using Cannulated Cancellous Screws Versus Kirschner Wires: A Six-Month Prospective Randomized Controlled Study

Brejesh K Prasad  1 , Naveen Kumar  1 , Vishesh Verma  1 , Vineet Pruthi  1
Affiliations

Tension Band Fixation for Displaced Transverse Patella Fractures Using Cannulated Cancellous Screws Versus Kirschner Wires: A Six-Month Prospective Randomized Controlled Study

Brejesh K Prasad et al. Cureus. .

Abstract

Background: The optimal fixation method for displaced transverse patella fractures remains debated. While Kirschner wire (K-wire) tension band wiring is traditional, cannulated cancellous screws (CCS) may offer superior biomechanical stability and clinical outcomes. This study compared functional and radiological outcomes of these techniques over six months.

Methods: We conducted a prospective, single-center, parallel-group randomized controlled trial following the Consolidated Standards of Reporting Trials (CONSORT) Outcomes 2022 guidelines. Forty patients with displaced transverse patella fractures (Association for the Study of Osteosynthesis (AO)/Orthopaedic Trauma Association (OTA) 34-C1) were randomly allocated to receive tension band wiring with either K-wires (n=20) or 4.0 mm CCS (n=20). The primary outcome was the Bostman score at six months. Secondary outcomes included the Visual Analog Scale (VAS) for pain, range of motion (ROM), radiological union, and complications.

Results: At six months, the CCS group demonstrated significantly superior Bostman scores (28.40 ± 2.65 vs 27.50 ± 3.15, p=0.032). The CCS group showed significantly lower VAS scores at all early time points and a better ROM (140° vs. 130°, p=0.015). Hardware-related complications were significantly lower in the CCS group (10% vs 50%, p=0.008), with reduced hardware removal requirements (5% vs. 30%, p=0.047). Return to pre-injury activity was higher in the CCS group (85% vs. 65%, p=0.021).

Conclusion: At six months, the CCS group achieved statistically higher but clinically marginal functional scores compared to K-wires, while also resulting in significantly less pain and far fewer hardware-related issues. This suggests that CCS fixation provides similar knee function, with added benefits of improved patient comfort, early rehabilitation, and a lower risk of complications.

Keywords: bostman's score; cannulated screw tension band; ccs; fracture patella; k-wire tbw; k-wiring; modified tension band wiring; tbw; tension band wiring; transverse patella fracture.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics committee, Employees' State Insurance Corporation (ESIC) Medical College, Faridabad issued approval (134X/11/13/2022-IEC/102). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Steps for open reduction and K-wire/Guidewire for fixation
(A-B): Skin incision and exposure of the fracture site; (C): Cleaning of fracture ends, removal of debris; (D): Fracture held with pointed patellar clamp; (E): Guidewire/K-wires passed across the fracture; (F- H): Corresponding C arm images K-wire: Kirschner wire
Figure 2
Figure 2. Canulated screw and tension band wiring
(A-B): Passing the cannulated cancellous screw along the guide wire, after pre-drilling with a canulated drill bit; (C-F): Step-by-step C arm images of the procedure
Figure 3
Figure 3. Bostman functional scores over a six-month follow-up period comparing K-wire and CCS tension band fixation
K-wire: Kirschner wire; CCS: cannulated cancellous screws
Figure 4
Figure 4. Comparison of complication rates at six months between K-wire and CCS fixation groups
K-wire: Kirschner wire; CCS: cannulated cancellous screw
Figure 5
Figure 5. Six-month postoperative outcomes of the patient operated on with cannulated cancellous screws and tension band wiring
Figure 6
Figure 6. Six-month postoperative outcomes of the patient operated on with Kirschner wire and tension band wiring
Figure 7
Figure 7. Preoperative and postoperative X-rays images of a patient operated with Kirschner wire and tension band wiring
(A) Preoperative X-ray; (B) at two weeks postoperative; (C) three months postoperative; (D) six months postoperative
Figure 8
Figure 8. Preoperative and postoperative X-rays images of a patient operated with cannulated cancellous screws and tension band wiring
(A) Preoperative X-ray; (B) at two weeks postoperative; (C) three months postoperative; (D) six months postoperative
See this image and copyright information in PMC

References

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