Patellar Fractures Treated by Modified Tension Band Wiring: A Clinical Study in a Teaching Hospitals.

Background: Patellar fractures are more common in country like India due to the activity of daily life and constitute 1% of all skeletal injuries by direct or indirect mechanism. Direct injuries due to the subcutaneous location of patella and indirect injuries because of forceful contraction of quadriceps with knee in flexed position are common. Thus, improper operative procedure can lead to disability in the patient. Therefore, this study was conducted to assess of advantages and complications associated with fixation technique so as to manage the fracture of patella. Methods: The study was conducted on 60 cases of transverse patellar fracture treated by Modified tension band wiring. All patients who had closed and open type I displaced transverse patellar fractures, acute fractures and who were medically fit for operative procedures were included in the study. Results: The most common age group in our study was 41-50 years. Male patients were 46 (76.7%) and female patients were 14(23.3%). Fracture due to direct injury was seen in 12(20%) patients and 48(80%) cases were with indirect trauma. Right side injury was seen in 26(43.3%) patients while 34 (56.7%) patients had injuries on the left side. The outcome of our study was excellent in 90% of cases, 8.3% was good and only 1.7% was poor. Conclusion: According to our study modified tension band wiring showed better outcome for the early mobilization and management of displaced transverse patellar fracture.

Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring

PURPOSE: We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture. MATERIALS AND METHODS: Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery. RESULTS: Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0°, external rotation 59.8°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points. CONCLUSION: For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.

Modified Tension Band Wiring Combined with Anti-Gliding Loop Augmentation Technique for the Treatment of Comminuted Patellar Fracture: Technical Note and Report of Early Results: Technical Note

In order to investigate the feasibility of a modified tension band combined with anti-gliding loop augmentation technique for the treatment of comminuted patellar fracture, 21 patients with comminuted patellar fracture were enrolled in this study. After the modified tension band wiring of patellar fracture, a cerclage wire was passed around the patella. Anti-gliding loops were made on the bending sites of Kirshner-wires. A knot was tied using both ends of the anti-gliding loops, and the cerclage wire was tightened using proximal knots. Bone union was achieved at 4.5+/-1.5 months postoperatively without nonunion. The Lysholm score was 87.1+/-2.8, and the range of motion of the knee was 2.1degrees+/-3.4degrees to 132.2degrees+/-6.5degrees at the last follow-up. The modified tension band combined with anti-gliding loop augmentation technique might be considered an alternative modification of modified tension band wiring for the treatment of comminuted patellar fracture.

Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

INTRODUCTION: Most patellar fractures are transverse involving the central third. Open reduction and stabilization of transverse patellar fractures is indicated if there is more than 2-3 mm of fragment separation and/or articular incongruity. SURGICAL TECHNIQUE: This study describes a percutaneous 2 cannulated screws and modified tension band wiring technique to treat transverse patellar fractures. MATERIALS AND METHODS: We performed 30 cases of displaced transverse patellar fractures with this technique. The clinical outcomes of these patients were evaluated with simple radiographs, range of motion and Lyshom score. RESULTS: This technique has shown to provide satisfactory clinical results and excellent knee functions. CONCLUSIONS: This technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

The Treatment of Patellar Fracture with Cannulated Screws and Modified Tension Band Wiring by Two Mini-incision Technique

PURPOSE: To evaluate that the radiological and clinical results of transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. MATERIALS AND METHODS: We reviewed 20 cases displaced transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. The radiological assessment was based on the time to union, maintenance of reduction. Mean duration of follow up was 27 months with mean age of 46 years. The functional outcome was assessed with the range of motion, complications and Lysholm score. RESULTS: All fractures was healed without displacement. The mean time to union was 7.3 weeks and degree of reduction were excellent in 11 cases and good in 9 cases and mean Lysholm score was 89 points(range, 81 to 95 points). We found no complication like limitation of range of motion of the knee, loss of reduction, irritation and migration of the hardware, and infection at last follow up. CONCLUSION: This surgical technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.

Modified Tension Band Technique With Looped Pin

PURPOSE: Fixation of fracture using modified tension band is a very useful treatment method, but loss of fixation caused by loosening of K-wires still remain problem. So we have studied the usefulness of modified tension band with looped pin in order to prevent loss of internal fixation. MATERIALS AND METHODS: From September 1999 to June 2002, we had treated 40 patients with this technique, including 16 patella, 8 olecranon, 8 distal clavicle fractures in which three were nonunion fractures, 5 ankle fractures and 3 acromioclavicular joint separations. We looped the pin which has been used for ring external fixator, in line with its long axis. RESULTS: After mean postoperative follow-up of 20 months, there were no loosening of looped pin in all cases and we obtained satisfactory results of functional evaluation. There were no complications of nonunion or metallic irritation. CONCLUSION: We concluded that modified tension band with looped pin could prevent displacement of internal fixation, and reduce the subsequent complications. Especially in elbow and shoulder joint that the displacement of fixation pin occured frequently, It was considered as very useful operative technique.

Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures

PURPOSE: To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle. MATERIALS AND METHODS: From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria. RESULTS: There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle. CONCLUSION: Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

The Treatment of Patellar Fracture with Modified Tension Band Wiring, using Cannulated Screws

PURPOSE: We have followed up the patients of the patellar fracture who had been treated with modified tension band wiring using cannulated screws. Since we have seen excellent clinical results, we would like to show the practical use of this operative method. MATERIALS AND METHODS: We analyzed the operation time, the time elapsed for union, and complications of 9 cases of the patellar fracture who were treated with this operative method at our hospital recently. RESULTS: Mean operation time (from the incision to the skin suture) was 68.3 min (40~120 min) and mean time elapsed for union was 9.7 weeks (8~12 wks). Mean time for full range of motion was 1 week in 5 cases of transverse fracture, 3 weeks (2~4 wks) in 3 cases of comminuted fracture. We found no complications like limitation of range of motion of the knee, loss of the reduction, irritation and migration of the hardware, and infection. CONCLUSION: This surgical technique provides stable fixation, allowes early motion excercise by minimizing injury to extensor mechanism and accompanies reduced rate of complications such as loss of the reduction, irritation or displacement of the hardware

Modified Tenson Band Fixation for Unstable Fracture of the Distal Clavicle / 대한정형외과학회잡지

PURPOSE: The aims of this study were to introduce a new surgical technique for unstable fracture of the distal clavicle, and to evaluate the clinical results. MATERIALS AND METHODS: The clinical results of nineteen patients who underwent surgical treatment for unstable fracture of the distal clavicle, during the period from March 1995 to December 1999, using a modified tension band fixation with follow up over one year were reviewed. Outcome was analyzed in terms of pain, function, radiologic result and union time. RESULTS: All cases showed satisfactory results; eighteen cases (95%) were excellent, and one case (5%) was good. Radiologic union was achieved on average at eight weeks (six-tweleve) after operation. No complications such as pin migration, metal breakage and nonunion were seen. CONCLUSION: Modified tension band fixation for unstable fracture of the distal clavicle was found to be a useful method, which is easy and induces no injury of the acromioclavicular joint, and provides enough stability for postoperative rehabilitation.