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Patella fractures are common injuries, often resulting either from ground-level falls on a flexed knee or from high-energy direct blows to the patella. Undisplaced fractures and vertical fracture patterns can often be successfully treated nonoperatively. Simple transverse fractures are amenable to tension band fixation. With activation of the extensor mechanism, the patella experiences a compressive force at its articular surface and a distractive force at its outer surface. Common constructs for fixation of patella fractures include a modified anterior tension band wiring with Kirschner wires and a stainless-steel “figure-of-eight” wire, as well as cannulated screws with a trans-patellar figure-of-eight wire. Adjuncts for comminuted fracture patterns include cerclage wires, multiple tension bands, interfragmentary screws, and defunctioning wires. Patella fractures have low rates of non-union, with most construct failures being attributed to technical error. Soft tissue complications and infection rates are reported from 0% to 4%. Anterior knee pain is common after patella fractures, even when treated nonoperatively. Rates of hardware irritation requiring removal are high, with many authors reporting between 15% and 30% removal. Tension band constructs using cannulated screws may have slightly lower hardware removal rates than constructs using Kirschner wires; however, no randomized controlled trials have compared this directly. No study has demonstrated a clinical difference in postoperative function or union between cannulated screw and Kirschner wire tension band constructs.
KeywordsPatella Fracture Tension band Tension band wire Cannulated screws Kirschner wire Extensor mechanism
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