Volume 13 Issue 3
Submission 16 July 2025
Acceptance 28 Aug 2025
Publication 4 October 2025
Comparison of the Outcome of Tension band with Cannulated screw and Tension band with Kirschner wire on Patella fracture
1Dr Ahmar Saleem, 2Dr Muhammad Akhtar, 3Dr Hammood ur Rehman, 4Dr Ibtesaam Haider, 5Dr Muhammad Ibrahim, 6Dr Aaqib Sarfaraz
1Postgraduate Resident, Orthopedic Unit, Services Hospital, Lahore
2Professor Orthopedic Surgery, Services Hospital, Lahore
3Postgraduate Resident, Orthopedic Unit, Services Hospital, Lahore
4Postgraduate Resident, Orthopedic Unit, Services Hospital, Lahore
5Postgraduate Resident, Orthopedic Unit, Services Hospital, Lahore
6Postgraduate Resident, Orthopedic Unit, Services Hospital, Lahore
Abstract
Background: Tension band wiring using Kirschner wires (TBW-KW) is the gold standard for patellar fractures, although complications are quite frequent. Cannulated screw fixation with tension banding (TBW-CS) has been suggested as an alternative.
Objective: To compare the clinical outcomes of cannulated screw tension band (TBW-CS) versus Kirschner wire tension band (TBW-KW) fixation among patients of patellar fractures.
Methods: This randomized controlled trial was conducted at the Department of Orthopedics, Services Hospital Lahore, over 6 months from Dec 15, 2024 till June 15, 2025. One hundred forty-eight (148) patients (18-80 years) with displaced or transverse patellar fractures (ASA-I/II) were randomized into TBW-CS (n = 74) or TBW-KW (n = 74) groups. Exclusion criteria were late presentation (>2 weeks), significant comorbidities or concomitant fractures. Outcomes measured were intraoperative blood loss, fracture healing time, and total efficiency of treatment. Data were analyzed with Mann-Whittney U and chi square tests, with the significance level p <= 0.05.
Results: Volume of blood loss was significantly less in the screw group (1.41 ± 1.19 ml vs. 1.78 ± 1.13 ml, p < 0.001). The healing time was shorter with screws (10.91± 1.30 vs 15.86 ± 1.55 weeks, p < 0.001). Overall efficiency was superior in the screw group (95.9% vs. 82.4%, p = 0.008). Subgroup analyses demonstrated that screw fixation was especially better in patients >50 years (p = 0.021), males (p = 0.002), transverse fractures (p = 0.033), ASA-II (p = 0.014), malnourished patients (p = 0.022), and early surgery <=72 hours (p = 0.009).
Conclusion: TBW-CS showed definite superiority in relation to TBW-KW with less blood loss, early healing, and greater treatment efficiency particularly in elders, malnourished, and ASA-II patients, also in transverse fractures, and in earlier interventions. Cannulated screw fixation is a preferred choice for most of the patellar fractures.
Keywords: Patellar fracture, Cannulated screw, Kirschner wire, Tension band wiring, Orthopedic fixation, Fracture healing.