Minimally invasive tension band wiring for displaced transverse patellar fractures

Background Patellar fractures account for ∼1% of all fractures. Most are transverse fractures involving the middle third of the patella in patients aged 20–50 years, and affect almost twice as many men as women. Patients and methods Percutaneous tension band wiring of 18 fresh transverse fractures of the patella with displacement of more than 3 mm in 18 patients was performed as a prospective study. The mean age was 40 years (range: 27–60 years). Results The average follow-up period was 30 months (range: 24–36 months). Radiological evidence of union was apparent in all cases at 8 weeks after surgery, with no hardware migration in 17 cases. Skin problems including superficial abrasions and contusions were encountered in 10 patients, which healed with local care, within the immobilization period. One osteoporotic female patient aged 60 years had proximal migration of one Kirschner wire, which necessitated replacement of the Kirschner wire with a thicker one 3 weeks postoperatively. Two cases had mild postoperative articular step-off but without patellofemoral arthritic changes on radiographs. Two patients encountered hardware irritation of the skin over the knee necessitating implant removal after the fractures were healed. Discussion and conclusion Percutaneous tension band wiring technique has many advantages, including minimal dissection of the soft tissues, good cosmesis, early rehabilitation, and shorter hospital stay.