Abstract

TENSION BAND FIXATION OF TRANSVERSE PATELLAR FRACTURES, COMPARISON BETWEEN CANNULATED SCREWS AND KIRSCHNER WIRES

*Dr. Mohammed Jalal, Dr. Ali Jamal Jarjies, Assis. Prof. Dr. Omar A. R. Barawi, Consultant Orthopaedist, Dr. Asou A. Baker, M. B. Ch. B. M.R.C.S.I

ABSTRACT

Introduction: The patella is the largest sesamoid bone in the human body and has a major role in extension of the knee. Patella fractures occur through excessive tension or by a direct external force, both disrupting knee extension. The purposeof our study is to compare the clinical outcomes of both cannulated screw and Kirschner wire fixation operations in patients with transverse fractures of the patella. Then drawing our conclusions on the superior type based on comparison of success and failure rates of both fixation types. Methods: We have performed a comprehensive electronic literature search on PubMed, Midline, Sciencedirect, Cochrane library, Access Medicine, and Google scholar databases to find relevant studies and articles conducted on penitents with patellar fractures. Targeted studies were studies which compared and evaluated clinical outcomes as well as rate of success and postoperative complications of both Kirschner wire and cannulated screws techniques of fixation. Case series reports, literature reviews, letter to editors, studies on animal and cadavers, as well as studies on partial or complete patellectomy are all excluded. Results and Discussions: We retrieved 107 researches but included 10 researches in our study. Four studies were comparative studies between Kirschner wire and cannulated screws. Three studies have used cannulated screw tension band as the choice for fixation of transverse patellar fractures. And three studies have used Kirschner wires for their patients. Overall, the 10 researches followed data records and surgical outcomes of 858 patients. These studies have concluded that cannulated screw tension band is a better management approach because of few characteristic linical outcomes such as: ―improved fracture reduction, reduced healing time, better Iowa scores, better Lysholm scores, Better HSS scores, better flexion and total range of motion (ROM), lower pain scores, lower rates major complications, no or lower reported cases of skin irritation, lower incidence of fixation failure, lower rates of infection, no or less numbers of implant removal.‖ Conclusion and Recommendations: Cannulated screw is superior to Kirschner wires in transverse fractions of patella. We recommend that surgeons could consider cannulated screw as an alternative to K-wire type of fixations. Meanwhile, morecomperative studies, randomized controlled trials, literature review, and meta-analysis studies are required about the same topic.

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