Tension band tendon-approximating cerclage for surgical fixation of patellar fractures: a novel surgical technique

Patellar fractures are potentially debilitating injuries due to loss of extensor mechanism function, resulting in an inability to extend the leg. Traditionally, these fractures have been surgically managed with open reduction and internal fixation using a tension band construct. This can be performed with K-wires or cannulated screws with suture or cable as the tension band. Plate osteosynthesis is another option that is increasing in popularity. Incorporating the tension band construct converts tensile force into a healing-compatible compressive force. However, these techniques often fail when used for comminuted patellar fractures. There is also a high reoperation rate due to metal implant discomfort. Reoperation rates have been reported as high as 41% for K-wires and 23% for cannulated screws. A more optimal technique would provide adequate reduction and strong fixation without the risk of implant irritation that can apply to all/most fracture types. We report a new technique that implements a multistrand, long-chain, ultra-high-molecular weight, polyethylene core suture material with a braided jacket of polyester (FiberWire) without the need for any associated plates, K-wires, or cannulated screws. The suture is woven to create a tension band tendon-approximating cerclage construct that incorporates the proximal and distal bone fragments as well as the patellar and quadriceps tendons. This technique can be used for both simple and comminuted fractures and provides optimal fixation strength while minimizing the complications associated with metal implants. The efficacy of this technique may lend to future studies including biomechanical and retrospective analyses.