A prospective study to compare the outcome of patellar fractures treated with tension band wiring versus cannulated cancellous screws fixation

The largest sesamoid bone in the body, the patella, is essential to the stability and functionality of the knee. It functions as a fulcrum to adhere to the patellar ligament and quadriceps tendon, increasing the quadriceps' effectiveness. Both static elements (ligaments and the joint capsule) and dynamic elements (muscles such as the hamstrings and quadriceps) are necessary for patella-femoral stability. Both direct trauma and indirect causes, such as falling when your quadriceps are clenched, can result in fractures. While direct blows might result in comminution and soft tissue injury, indirect injuries usually cause damage to the tendons or bones.There are different ways to treat fractures. For fractures with less than 2 mm displacement, non-operative treatments can be used. Surgical alternatives include screw fixation, tension band wiring and partial or complete patellectomy. It is a comparative randomized control trial.The purpose of this study is to evaluate the cannulated cancellous screws techniques in terms of safety and outcome when compare to tension band wiring for treatment of displaced transverse patellar fractures. A longitudinal observational study was carried out in the department of orthopaedics for a time period of 20 months from November 2020 to June 2022. Patients were divided into two groups one treated with cannulated cancellous screws and another treated with tension band wiring then followed up at intervals of 1st, 3rd and 6 month Results were evaluated with regard to union rate, ROM, pain score, functional outcome, complications and hardware removal rates. The mean radiological union was 9.2 weeks in cannulated cancellous screws group and 9.73 weeks in tension band wiring group, The mean knee ROM was 135° in cannulated cancellous screws Group and 129° in tension band wiring group andfunctional score in cannulated cancellous screws group was 66.7% excellent, 26.6% good and 6.7% poor outcomes. In tension band wiring group functional score was 46.6% excellent, 40% good and 13.4% poor outcomes as per WEST’S Criteria. Complications encountered in tension band wiring group were more with respect to hardware prominence, soft tissue irritation and hardware removal rates than cannulated cancellous screws group. Cannulated cancellous screws for treatment of displaced transverse patella fracture are safe and biomechanically stable implant with lesser degree of soft tissue irritation when compared to tension band wiring.