Combined Cerclage and Figure-of-eight Tension-band Wiring without K-wire Versus K-wire Tension Band Wiring Fixation for Transverse Patellar Fractures: A Prospective Comparative Study.

Abstract

Introduction: Conventional modified tension-band wiring (TBW) using Kirschner wires (K-wires) is widely used for displaced transverse patellar fractures but is associated with implant prominence, irritation, migration, and breakage. K-wire-free fixation using combined cerclage and TBW may provide stable fixation while reducing hardware-related complications.

Materials and methods: Prospective comparative study of 156 patients with transverse patella fracture with follow-up of at least 18 months. Group A consisted of 82 patients treated with K-wire TBW and Group B consisted of 74 patients treated with combined cerclage TBW without K-wires. Clinical assessment was done by knee range of motion, extension lag, and presence of local tenderness. Pain assessment was done using the Visual Analog Scale. Functional assessment was performed using the Bostman knee score. Radiological assessment was done using standard radiographs of the knee. Complications and implant removal were also assessed. The Chi-square test, Fisher's exact test, and independent-samples t-test were used to assess association. P < 0.05 was considered satistically significant.

Results: Both groups were comparable in demographics such as age, gender, body mass index, and follow-up period. The combined cerclage TBW without K-wires group demonstrated significantly lower pain scores at 6 weeks, 3 months, and 6 months and less knee tenderness at 6 weeks and 3 months. Bostman scores were significantly higher at 6 months and 1 year. The pain and stair-climbing components of the Bostman score were significantly better in the combined cerclage group at 6 months and 1 year. Implant migration/breakage (2% vs. 17%) and hardware irritation (10% vs. 17%) were significantly reduced with combined cerclage TBW. Implant removal preference (16% vs. 43%) and actual removal surgery (13% vs. 31%) were also significantly lower.

Conclusion: The study demonstrates that combined cerclage TBW without K-wires provides functional outcomes comparable to those of conventional modified TBW with K-wires at 1 year, while potentially reducing K-wire-related complications such as implant migration, prominence, irritation, and subsequent implant removal surgery.