STUDY BETWEEN SURGICAL FIXATION OF PATELLA WITH CERCLAGE AND TENSION BAND WIRING TECHNIQUE AT SSPM’S MEDICAL COLLEGE

Abstract

Introduction: In human body among the skeletal system patella is the largest sesamoid bone in the quadriceps tendon in the body. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. Usually with direct trauma there is occurring of patellar facture. Surgery is required for about one third of patella facture that indicated damage to the extensor mechanism. In a country like India any improper and inadequate treatment would inevitably lead to a great deal of disability where scooching is an important activity in daily life. Regarding treatment of patellar fracture there is a controversy since earliest time. In the facture of patellar with displacement less than 3mm, conservative treatment was suggested as the best option. There are various methods used for ORIF of these fractures tension band wiring (TBW) technique using wires and most commonly used is stainless steel wires. In the treatment of TBW which works by converting tensile forces into compressive forces when movements occur at the knee Joint. However TBW is consider as current gold standard for the displaced transverse patella fractures whereas some surgeons recommend augmentation of TBW with circumferential cerclage wiring to enhance the strength of the fixation. Aim: The main aim was study between fracture fixation of patella with cerclage and Tension Band wiring technique. 

Material and methods: Total 62 patients with fracture of patella were included in this study with the age more than 20 years.  Among total patients were divided into two groups as group I (n=30) include facture treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring whereas in group II (n=32) included fractures treated by TBW along. Patients with facture of patella, extensor mechanism lag at knee and with closed injury were included in this study.  Almost for all the patients surgery was performed and tourniquet was also used.  By using a midline longitudinal incision surgery was done over anterior aspect of the knee. By using tension band wiring with or without augmented cerclage with stainless steel wire open reduction and internal fixation were done. After the surgery as post operative knee brace was given so that patients could start range of motion at knee without pain. To make sure that whether proper fixation was done or not Post-operative radiographs were also done.

 Result: In this study total 50 patients were included in which 34(68%) were male and 16(32%) were female. Among 50 patients was included different age group in which more patients were in the age group of 40-50 years old as 36%.

 Conclusion: Conservative treatment is only in un-displaced fractures. For the facture of patella it is important for operative treatment to carry out repair of torn expansion of quadriceps and gives good results. Therefore, in the facture of patella modified TBW was better than encirclage wiring in treatment probably because of good stability of implant and easier postoperative rehabilitation. Hence use of circumferential cerclage wiring along with tension band wiring for fractures of patella has no added advantage over fixation with tension band wiring alone.

Keywords: Patella fracture, Cerclage wiring, Tension band wiring