A study to assess the functional outcomes of surgical intervention in patellar fractures and make a comparison between tension band wiring and partial patellectomy
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 522-528
AbstractIntroduction: Surgical treatment of patellar fractures has evolved over the years. It ranges from partial
or total patellectomy to open reduction internal fixation using tension band wiring and constructs.
Previous studies have documented conflicting results regarding clinical and functional outcomes after
surgical treatment of patellar fractures.
Aim: To assess the functional outcomes of surgical intervention in patellar fractures and make a
comparison between tension band wiring and partial patellectomy.
Methods: 46 patients with patellar fractures were included in this prospective longitudinal study.
Depending on the fracture type surgical intervention in the form of tension band wiring of the patella in
24 patients and partial patellectomy in 22 patients was done. Postoperatively, the functional outcomes
were measured at three months, six months, and the latest follow-up. The outcome variables used were
Knee Injury and Osteoarthritis Outcome Score (KOOS), extensor lag, range of knee flexion, thigh
circumference, Medical Research Council (MRC) grading of quadriceps and hamstrings strength and
complications in treated patients. Levene’s test, T test and chi-square test were used to compare the
these outcome variables.
Results: KOOS score was significantly better (P value of 0.001) and thigh wasting was less (P value of
0.09 and 0.412) at three and six months in the tension band wiring (TBW) group. Knee flexion (P value
of 0.001) and extensor lag (P value of 0.02) had significantly better outcome in the TBW group at three
months, but a similar outcome to the partial patellectomy group at six months (P value >0.05). All the
patients had regained their full quadriceps/hamstring muscle strength at six months. Fracture union was
assessed at six months and showed a significantly better union rate in tension band wiring when
compared to partial patellectomy (P value < 0.05).
Conclusions: Operative management of patellar fractures gives good to excellent functional outcomes
at short to midterm follow-up with minimal complications, irrespective of the type of procedure.
Comparable functional outcomes can be expected following patellar osteosynthesis and salvage
procedure. However, future studies with bigger sample size and longer follow-up are needed.
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