Comparative clinical efficacy and cost-effectiveness of modified tension band wiring techniques in patellar fracture repairs

Patellar fractures challenge knee function recovery. Traditional tension band wiring (TBW) suffers from K-wire complications and inadequate fracture site compression, prompting modified techniques. We hypothesized that a cerclage-free modified TBW (Group A) would outperform titanium cable TBW (Group B) and titanium cable TBW with cerclage (Group C) in cost, complications, and functional outcomes. In this retrospective study (Level IV evidence), 83 patients (aged 18-80) with unilateral closed transverse patellar fractures (December 2018-2023) were grouped by fixation method. Group A incurred the lowest hospital costs, and Group C had the highest. Operation time was significantly shorter in Group B. However, Groups A and B outperformed Group C in postoperative recovery time, early functional exercise initiation, Lysholm score at 1 year postoperatively, and complication rates. Modified TBW without cerclage demonstrated cost efficiency, reduced complications associated with earlier rehabilitation initiation compared to cerclage-augmented techniques.