Historically, the most commonly used technique for managing patellar fracture fixation is represented by the modified tensionband wiring technique 5, 19, 23. Efficacy of kwire tension band fixation compared with. Tension band for patella frx wheeless textbook of orthopaedics. However, it suffers from distinct disadvantages such as implant irritation, need for open reduction, incidence of palpable implants, and need for subsequent implant removal. Tension band wiring of transverse fractures of patella. Modified tension band wiring using fiberwire for patellar. Early mobilisation is important but can cause detrimental displacement at the fracture site. Biomechanical analysis of tension band wiring tbw of transverse. Comparison of displaced patellar fracture treatment by two. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to.
Patella, fracture, internal fixation, tension band wiring. Tensionband wiring of transverse fractures of patella. Modified tension band technique for patella fractures sciencedirect. Wires are used as tension band most commonly in patella and olecranon fractures. The patella is the largest sesamoid bone in the human body. Comparison of the outcomes of cannulated screws vs. For displaced fracture surgical intervention is a must.
Comminuted patellar fractures usually occur with direct trauma. Pain, operating time, mobility, functional score, and complications were evaluated. The tension band with the cannulated screw is the same as the k. Modified tension band wiring has been widely used to treat transverse patellar fractures. Tension band wiring is commonly used to treat displaced patella fractures. The use of tension band wire technique for patella fractures fixation is a wellestablished technique. Lumbar spine transverse process fracture everything you need to know dr. Percutaneous cannulated screws with tension band wiring. The direct force often results in comminuted or due to violent contraction of. Among all fracture types of the patella, transverse fracture of the body is the most common 1,2,3,4.
Modified tension band wiring of patellar fracture as a. Patella fracture orif with tension band trauma orthobullets. From march 2016 to march 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two kirschner wires kwires and fiberwire. In the patella, an anterior figureofeight wire loop acts as a tension band during flexion of the knee. Doubletension wire management of nonunion patella with. Standardized mean difference smd or relative risk rr and their. Nov 29, 20 although the modified tension band wiring is still the most frequently applied internal fixation technique for transverse patella fractures, postoperative symptoms and complications related to this technique are not uncommon. Patella fracture, open reduction, internal fixation, tension band wiring, cerclage wiring. Multifragmentary patellar fractures cannot be fixed with a tension band. The use of tension band wire technique for patella fractures fixation is a. In the 1950s, the technique of tensionband wiring was first described, and later.
Tension band wiring tbw of patella is one of the most common and popular. Modified tension band wiring tbw, one of the most common surgical fixation methods for patellar. It is accepted that where fixation is required it needs to be rigid and tension band wiring using cannulated screws or kwires is the accepted standard. Wiring or technically tension band wiring of the patella is a common way to treat patella kneecap fractures. Oliver, md, columbia, mo demonstrates patella fracture fixation using 4. Tension band wiring is a fixation technique which results in. Cannulated screw prominence in tension band wiring of. Tension band wiring for complete articular, frontal. Laith jazrawi of nyu langone orthopedics demonstrates patella fracture open reduction and internal fixation using cannulated screws and tension band wiring. May 03, 2017 wiring or technically tension band wiring of the patella is a common way to treat patella kneecap fractures. Tension band stitch for complete articular, frontal.
Tension band wire for patella fracture touch surgery. The goal of this study was to assess the outcome and implant. Patella fractures, percutaneous wiring, functional outcome 1. What goes on in a procedure for removing wires from around. Modified tension band technique for patella fractures. Other indications are tuberosity of the humerus, of the lateral. If a tension band produces fairly constant force at the fracture site during motion, such as at the medial malleolus, it is called a static tension band. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar. It is surgically managed by tension band wiring around the knee. Ota video library orif patella fracture with tension band. However, few studies have evaluated the clinical outcomes using different methods of kirschner wire bending, location of the tension band, and depths of kirschner wires.
Percutaneous tensionband suture technique for distal patella. A tension band wire is a form of orthopaedic internal fixation method used to convert distraction forces into compression forces, promoting bone healing. To be able to use a tension band, the posterior articular cortex cannot be comminuted as it must provide a buttress to allow compression. Open reduction and internal fixation using tension band wire technique using pins and wires and a figure of eight to press the pieces together pop cast in extension for 6 weeks. Anatomical features include the proximal articular body, with an.
Management of comminuted patellar fracture fixation using. Post surgically the leg is immobilised by cylindrical plaster cast immobilisation for 3 to 4 weeks. The modified anterior tension band technique with kirschner wires kwires is one of the most common methods used for fixation of simple midpole patella fractures. The most commonly used technique for managing patella fracture fixation involves a modified tension band wiring technique 47 with longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior surface of the patella, through an extensile incision. Another tension band wire was passed through the neutralization hole made just posterior to the tibial tuberosity and the retinaculum was repaired. However, the standard technique, which involves using two kirschner wires through the patella, can cause problems with prominent hardware, and difficulty capturing the change to figure of eight wire. To evaluate outcome of percutaneous tension band wiring for transverse fractures of the patella. Tension band wiring for complete articular, frontalcoronal. Dec 20, 2017 tension band wiring application and principles fracture patella olecrnon greater trochanter medial malleoli clavicle slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. The cannulated screws compress the fracture and the blunt tips prevent lacerations to the fibertape. The quadriceps produces significant forces on patellar fractures. Depending on fracture stability motion will increase the interfragmentary compression. Although the modified tension band wiring is still the most frequently applied internal fixation technique for transverse patella fractures, postoperative symptoms and complications related to this technique are not uncommon. Casebased instructional video discussing indications for tension band fixation of patella fractures with intraoperative instructions and surgical tips.
The wires help keep the bones together while they heal. Arthrex patella fracture fixation using cannulated. Ao foundation patella fracture tbw tension band youtube. Horizontal versus vertical orientation of the loop for. Implant removal following surgical stabilization of. Register your interest and we will get in contact with you. Fixation of comminuted patellar fracture with combined. Implant removal following surgical stabilization of patella. Conversely, if the compression increases with motion, such as in the patella with knee flexion, the tension band is called. In the prominent screw group, screw length was 15% longer than the measured trajectory, resulting in 4 to 6 mm of additional length. Ota video library orif patella fracture with tension band construct on vimeo. Cannulated screw prominence in tension band wiring of patella. Register your interest and we will get in contact with you shortly. Oct 09, 2015 plate versus tension band wire fixation for olecranon fractures duration.
Patella, fracture, tension band wiring, internal fixation introduction patella is the largest sesamoid bone in the body situated in front of knee. Tension band wiring with cerclage wiring is most widely used for treating displaced patellar fractures. Although wire breakage is not uncommon, migration of a fragment of the broken wire is rare, especially migration into the knee joint. The tension band wiring technique is the most common method of transverse patella fracture fixation 1, 2, 5, 810. Although the kwire and tension band technique remains popular, patients frequently complain of discomfort secondary to prominent hardware, leading to high rates of removal of hardware roh.
Undisplaced fracture is managed by cylindrical plaster cast immobilisation for 2 to 3 seeks. Unfortunately in as much as 3040% of patients these wires can become problematic. Historically, the most commonly used technique for managing patellar fracture fixation is represented by the modified tension band wiring technique 5, 19, 23. The effect of site of wire twists and orientation of stainless steel wire loop. Arthrex patella fracture fixation using cannulated screws. Tensionband wiring is commonly used to treat transverse patella fractures. Other indications for tension band wiring greatertuberosity of humerus 25. Oct 11, 2006 tension band wiring is commonly used to treat transverse patella fractures.
A fragment displacement of 2 mm was observed in 22%30% of the patients with early mobilization after tension band. Orif patella fracture postoperative rehabilitation protocol name. Gap formation was measured over 40 loaded flexionextension cycles 90 to 5. Transverse fracture of patella tbw tension band youtube. Feb 19, 20 treatment options for comminuted patella fractures 21. A tension band can produce compression statically or dynamically. A smaller incision with percutaneous fixation may be an. In comminuted patellar fractures, we performed modified tension band wiring using a fiberwire arthrex instead of the conventional methods. Orif patella fracture postoperative rehabilitation protocol. Pdf percutaneous tension band wiring for patellar fractures. Patella fracture, cerclage wiring, tension band wiring introduction patella fractures account for 1% of all skeletal fractures1. To compare the efficacy and safety of kwire tension band fixation ktb with other alternative approaches cannulated screws, cable pin, and ring pin for treatment of patella fractures by performing a metaanalysis. Tension band wiring is an optimal mechanical principle for early functional motion.
Operative treatment is recommended for displaced patellar fractures. Percutaneous tension band wiring for patellar fractures. Treatment of displaced transverse fractures of the patella. It is located within the extensor apparatus of the knee. Pubmed and embase databases were searched for all relevant studies. Treatment options for comminuted patella fractures 21. Patella fractures account for 1% of all fractures but there is little in the contemporary literature regarding outcomes. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such.
Fixation of patellar fractures is very crucial as it allows early. Introduction patella is the largest sesamoid bone and has an important role in function of the knee extensor mechanism. Patella fracture reduction and fixation using cannulated. Modified tension band wiring of patellar fracture as a techn. We describe here a rare case of migration of a wire fragment into the posterior septum of the knee joint after fixation of a displaced patellar fracture with.
The most common configuration has parallel kirschner k wires and a stainless steel wire loop placed in a vertically oriented figure of eight. Factors affecting the outcomes of modified tension band. The most commonly used technique for managing patella fracture fixation involves a modified tensionband wiring technique 47 with longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior surface of the patella, through an extensile incision. An example xray demonstrating fracture of the patella. It involves longitudinal kirschner wires kwires and 18gauge stainless steel wire in a figureofeight pattern looped over the anterior side of the patella. Introduction patella, the largest sesamoid bone is located in the extensor apparatus of the knee which is. K wire fixation with tension band wiring has conventionally been used for the open reduction and internal fixation of the patella. Functional outcome with modified tension band wiring. This technique, although used widely, has certain distinct disadvantages. Fiberwire tension band for patellar fractures springerlink. Displaced patellar fractures treatment options for lowerpole fractures or patellar tendon rupture polar 24. Case reports in orthopedics hindawi publishing corporation.
Each patella was transversely osteotomized at its midportion and fixed with screws and an anterior tension band. The patient underwent surgery by anterior approach where quadricepsplasty and tension band wiring for the patella were performed after bringing the superior fragment down figure 2. If displaced, it should be repaired surgically to restore the function of extensor mechanism and aid in fracture healing 5, 6. Explain the principle of tension band wiring sum up the indications for tension band wiring. Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. Comparison of a novel tension band and patellotibial. Berg ee et al 14 shows that radiological union of transverse fracture of patella was seen at a mean age of week. A century ago, a report of 1100 patella fractures clearly established operative internal fixation as the standard of care for displaced fractures of the patella. Ota video library orif patella fracture with tension. Tension band wiring tbw technique, one of the most commonly used surgical method in treating a tension fracture 7,8,9,10, has a sound.
The combination of cerclage and tension band wiring proved to be significantly stronger and is recommended. The most common configuration has parallel kirschner k wires. Comminuted fracture circlage wire and k wirefixation 22. Patellar fractures account for approximately 1% of all skeletal fractures. Patella fracture reduction and fixation using cannulated screws and tension band wiring by nyu langone orthopedics featuring dylan lowe, laith jazrawi january 2018. Percutaneous tensionband suture technique for distal. About one third of patella fractures require surgery, which is indicated if there is damage to the extensor mechanism or in fractures associated with 2. Surgical treatment of transverse patella fractures with this percutaneous cannulated screws with tension band wiring technique, which combined the advantages of rigid internal fixation and minimally invasive surgery, has shown to provide satisfactory clinical results and excellent knee functions, with less pain and low incidence of complications. Plate versus tension band wire fixation for olecranon fractures duration. In the 1950s, the technique of tensionband wiring was first described, and later biomechanical studies showed it to be superior to intraosseous wire suture.