Background: Patella is the largest sesamoid bone in the body and is situated in front of the knee joint. Patellar fractures are encountered very frequently in day to day clinical practice due to increase in accidents.



Objective: Present study is carried out to know the role of tension band wiring in management of fracture of patella.



Material and Methods: This study was conducted during April 2003 to July 2005. All the patients were following trauma and all were treated, followed up and studied according to a fixed protocol. History of all patients was taken and local, general as well as radiological examinations were done. After confirmation of diagnosis patients were admitted with posterior cylindrical slab. After that preoperative evaluation was done and one the patient was fit for surgery, he was operated on appropriate day. Fracture fragments were reduced and then fixed with k-wire. Reduction was confirmed on IITV (image intensification Television).



Result: In the patients after tension band wire insertion, 120-130 degree flexion was present in 50% patients, quadriceps strength was equivalent to opposite limb in 90% patients, difficulty in sitting cross legged /squatting was present in 50% patients, change of work was observed in 25% patients, infection was observed in 5% patients, non union or mal union was not observed in any patient. 



Conclusion: Tension band wiring produces good results when there is minimal or no communication and exact reduction of articular surface is achieved. Our results are comparable with some of studies conducted in India and abroad

Chirag V Thakkar

Rosy Parmar

Tarun Desai

Journal of Research in Medical and Dental Science

Directory of Open Access Journals

Thakkar CV et al: Role of Tension band wiring in management of fracture of patella                                                        www.jrmds.in 
 
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 4 | October – December 2014  63 
 
 
Study of tension band wiring in management of fracture of patella in 
tertiary care hospital in Vadodara 
 
Chirag V Thakkar*, Tarun Desai**, Rosy Parmar*** 
 
*Associate Professor, **Assistant Professor, Orthopedic Department, GMERS Medical College, Gotri, Vadodara, Gujarat, India 
***Assistant Professor, Microbiology Department, GMERS medical College, Gotri, Vadodara, Gujarat, India 
 
DOI: 10.5455/jrmds.20142412 
 
ABSTRACT 
 
Background: Patella is the largest sesamoid bone in the body and is situated in front of the knee joint. Patellar 
fractures are encountered very frequently in day to day clinical practice due to increase in accidents.  
 
Objective: Present study is carried out to know the role of tension band wiring in management of fracture of patella.  
 
Material and Methods: This study was conducted during April 2003 to July 2005. All the patients were following 
trauma and all were treated, followed up and studied according to a fixed protocol. History of all patients was taken 
and local, general as well as radiological examinations were done. After confirmation of diagnosis patients were 
admitted with posterior cylindrical slab. After that preoperative evaluation was done and one the patient was fit for 
surgery, he was operated on appropriate day. Fracture fragments were reduced and then fixed with k-wire. Reduction 
was confirmed on IITV (image intensification Television). 
 
Result: In the patients after tension band wire insertion, 120-130 degree flexion was present in 50% patients, 
quadriceps strength was equivalent to opposite limb in 90% patients, difficulty in sitting cross legged /squatting was 
present in 50% patients, change of work was observed in 25% patients, infection was observed in 5% patients, non 
union or mal union was not observed in any patient. 
 
Conclusion: Tension band wiring produces good results when there is minimal or no communication and exact 
reduction of articular surface is achieved. Our results are comparable with some of studies conducted in India and 
abroad. 
 
Key words: Tension band wiring, k-wire, fracture of patella 
 
 
INTRODUCTION 
 
Patella is the largest sesamoid bone in the body and it 
is situated in front of the knee joint. It is an integral 
part of the skeleton phylogenetically inherited. Patella 
develops independently and not in quadriceps tendon 
as it was believed. It develops behind the quadriceps 
tendon. Quadriceps tendon subsequently attains 
attachment to patella [1].  
 
Patellar fractures constitute 1% of total body fractures 
[2]. Broadly patellar fractures can be classified in 
open and closed categories and then subsequently 
can be classified according to their pattern of 
fractures like vertical, transverse, comminuted 
fractures of upper pole and fractures of lower pole. As 
patella is critical for extensor mechanism of knee to  
 
function normally and total patellectomy always fails 
in preserving normal extensor mechanism of knee 
joint, patella should be preserved as far as possible. 
The results have shown that total patellectomy 
causes various post patellectomy symptoms and 
significant disability or instability [3]. 
 
A tension band is a device which will exert a force 
equal in magnitude but opposite in direction to the 
bending force. The tension band must be made up of 
a material which resists tensile forces and which can 
be pre-stressed. The bone must be able to withstand 
compression. This means that the bone must not be 
comminuted either under or on the opposite side from 
the tension band [4]. 
 
Original Article 
Thakkar CV et al: Role of Tension band wiring in management of fracture of patella                                                        www.jrmds.in 
 
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 4 | October – December 2014  64 
 
Pauwel first used this principle in the management of 
displaced patellar fractures. Initially tension band 
wiring was done directly through the patellar and 
quadriceps tendon. Here the fracture was exposed 
and reduced and then a stainless steel wire was 
passed under the quadriceps tendon then over the 
patella and then beneath the patella tendon and then 
the loop was tightened over the patella to get and 
maintain the reduction. Later this method was 
modified and the two k-wires were passed parallel 
through the fracture and then over it the tension band 
figure of eight loop was made with wire. This method 
works with the principle that this anterior tension band 
neutralizes the large distraction force that occurs 
across the anterior surface with contraction of the 
quadriceps and also with flexion of the knee. As 
tension is resisted by this wire, compressive forces 
are generated at the posterior aspect of the fracture 
gap, improving stability at the articular surface [4]. 
 
MATERIAL AND METHODS 
 
Study duration & sample size: This study was 
conducted at department of Orthopedics at S.S.G. 
Hospital, Vadodara from April 2003 to July 2005. This 
is a study of 20 cases of closed fracture of patella 
treated by tension band wiring. It is a study of 
subjective assessment and objective analysis of the 
quadriceps and knee function after treatment of 
fracture of patella. 
 
Patients were followed up in the period from 01/04/03 
to 01/07/05. Only those cases were included in 
analysis that had a minimum follow up period of five 
months. All the patients were following trauma and all 
were treated, followed up and studied according to a 
fixed protocol. 
 
Methodology: As soon as the patients arrived in 
OPD (outpatient department) or casualty department, 
patient’s history was taken, general & local 
examination were done, radiological examination was 
done and once the diagnosis was confirmed after x-
ray then the patient was shifted to admitting ward with 
posterior cylindrical slab. Once the patient was 
admitted in the ward all pre operative blood 
investigations were done and once patient was fit 
anaesthetically for surgery, he was posted for elective 
surgery on appropriate day. 
 
The fracture was approached via a midline 
longitudinal incision. The fracture site was irrigated to 
remove the blood clots and debris, and the integrity of 
the fragments was evaluated. Once the fracture was 
reduced, two parallel kirschner wires were passed 
from the superior pole of the patella to the inferior 
pole across the fracture site, 5mm posterior to the 
anterior cortical surface. Then an 18G wire was 
passed transversely through the quadriceps tendon 
attachment, then across the anterior surface of 
reduced patella, then the wire was passed 
transversely deep to the patellar tendon attachment 
on the inferior fragment and deep to the protruding 
Kirschner wires, then back over the anterior patellar 
surface to form a knot. 
 
In follow up we have seen for knee ROM (range of 
movement) by extensor leg, flexion restriction and 
quadriceps strength. Functional activity was checked 
by walking, squatting, sitting cross legged, ascending 
stairs leading with affected leg first, descending stairs 
leading with affected leg first & standing on affected 
limb. Final follow up was done with x-ray to see union 
at fracture site. 
 
Ethical clearance:  Ethical clearance was taken by 
ethical committee of our institute. 
 
RESULTS 
 
In our study the male to female ratio was 4:1, 16 
(80%) patients were males & 4 (20%) were females 
as shown in table-1.  
 
Table 1:  Sex & age wise distribution of patients 
 
Variable Numbers % (n=20) 
Sex 
Male 16 80 
Female 4 20 
Age (years) 
21-30 4 20% 
31-40 3 15% 
41-50 4 20% 
51-60 6 30% 
61-70 3 15% 
Total 20 100% 
 
 
Table 1 shows that highest number of patients in 51-
60 years age group, decrease in number in 21-30 & 
41-50 years age groups & lowest number of patients 
in 31-40 and 61-70 years of age groups. Mean age 
was 48 years. 
 
Thakkar CV et al: Role of Tension band wiring in management of fracture of patella                                                        www.jrmds.in 
 
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 4 | October – December 2014  65 
 
Table 2: Activities examined after surgery 
 
Activity 
Possible 
with ease 
(%) 
Possible 
with 
difficulty 
(%) 
Not 
possible 
(%) 
Can walk 
without pain 
or support 
20 (100) 00 00 
Sitting cross 
legged 
10 (50) 5 (25) 
5 (25) 
 
Squatting 10 (50) 5 (25) 
5 (25) 
 
Ascending 
stairs with 
affected leg 
first 
20 (100) 00 00 
Descending 
stairs with 
affected leg 
first 
20 (100) 00 00 
Standing 
without 
support 
20 (100) 00 00 
Lifting 
/carrying 
weight 
20 (100) 00 00 
Climbing 
slopes 
20 (100) 00 
00 
 
Walking on 
uneven 
ground 
20 (100) 00 00 
Standing on 
affected leg 
20 (100) 00 00 
 
Table 3: knee ROM (range of movement) 
 
Max flexion 
possible 
Numbers %  (n=20) 
120-130 degree 10 50 
90-120 degree 5 25 
<90 degree 5 25 
Total 20 100 
 
 
Table 2 shows activities examined after surgery. 
Walking without pain or support was seen in 100% 
patients which was possible with ease. Sitting cross 
legged was possible with ease in 50% patients, was 
possible with difficulty in 25% patients & was not 
possible in 25% patients. Squatting was possible with 
ease in 50% patients, was possible with difficulty in 
25% patients & was not possible in 25% patients. 
Ascending stairs with affected leg first, Standing 
without support, Lifting /carrying weight, Climbing 
slopes, Walking on uneven ground & Standing on 
affected leg was possible with ease in 100% patients. 
Table 3 shows that 50% of patients had full flexion of 
the knee joint (120-130 degrees), 25 % of patients 
had restriction of flexion and in 25% of patients flexion 
was less than 90 degrees. 
 
DISCUSSION 
 
In our study  80 %  patients were male and 20% 
patients were female , while in Levack et al [5] & in 
Mehdi [6] study 72% patients  were male  & 28% 
patients were female, in Siddaram N Patil [7] study 
70% patients were male and 30% patients were 
female & in Mugadlimath et al [8] study 60% patients 
were male and 40% patients were female. This can 
be explained by the working habits prevalent in our 
country where most of the outdoor work & manual 
labour is done by males, hence high preponderance 
of male patients. 
 
The fracture of patella is common in all age groups 
with no age specificity. In our study age varied from 
22 years to 65 years with mean age of 48 years, while 
in Levack et al [5] study mean age was 49 years, in 
Mehdi [6] study mean age was 36 years & in 
Siddaram N Patil [7] study mean age was 42.05 
years. 
 
Difficulty in sitting cross legged & squatting was 
observed in 50% patients in Levack et al [5], in 17% 
patients in Mehdi [6], in 30% patients in Mugadlimath 
et al study [8] & in 50% patients in present study. 
Quadriceps strength was comparable to opposite limb 
in 50% patients in Levack et al [5], in 83% patients in 
Mehdi [6], in 70% patients in Mugadlimath et al [8] & 
in 90% patients in present study. 
 
120-130 degrees flexion was observed in 50% 
patients in In Levack et al [5], in 83% patients in 
Mehdi [6], in 70% patients in Mugadlimath et al [8] & 
in 50% patients in present study as shown in table 3.  
 
CONCLUSION 
 
Based on our study we have reached to the 
conclusion that tension band wiring produces good 
results when there is minimal or no comminution and 
exact reduction of articular surface is achieved. 
Supervised physiotherapy plays pivotal role in final 
outcome of treatment. So tension band wiring is the 
gold standard treatment for fracture of patella 
producing excellent results. 
 
REFERENCES 
 
1. Mc Keever DC . Patellar Prosthesis. J. Bone Joint 
surg [Am] 1955;37-A:1074-84. 
Thakkar CV et al: Role of Tension band wiring in management of fracture of patella                                                        www.jrmds.in 
 
Journal of Research in Medical and Dental Science | Vol. 2 | Issue 4 | October – December 2014  66 
 
2. A. Paige Whittle, George W. Wood II. Mosby 
publications 2003. In: Campbell’s operative 
orthopaedics, Vol III, 10
th
 edition. Chapter 51: 
Fractures of lower Extremity, p. 2796. 
3. Crenshaw AH, Wilson FD. Surgical treatment of 
Fracture of patella. J Bone Joint Surg. 1954;36A: 
431. 
4. R A Marder, TV Swanson, NA Sharkey, PJ 
Duwelius. Effects of partial patellectomy and 
reattachment of patella tendon on patella-femoral  
contact  areas an pressure. J Bone Joint  Surg. 
Jan 1993;75(1):35-45. 
5. Levack B, Flannagan JP, Hobbs S. Results of 
surgical treatment of patellar fractures. J  Bone 
joint Surg. May 1985;67(3):416-9. 
6. Mehdi M. Treatment results of fractures of the 
patella using pre-patellar tension band wiring. 
Analysis of 203 cases. Ulus Trauma Derg. Jan 
2001; 56-9.  
7. Siddaram N Patil. A Prospective Clinical Study Of 
Patellar Fractures Treated By Modified Tension 
Band Wiring.  Int J Biol Med Res. 2014; 5(2):3975-
80. 
8. Mugadlimath Anand, Dinesh Gudapati, 
Chandrakanth V, Praveen Kumar Reddy, P 
Akshay TM, Arun KN. Clinical evaluation of the 
modified tension band wiring technique for the 
fractured patella. International Journal of 
Biomedical and Advance Research 2014; 05 
(01):20-2. 
 
Corresponding Author:  
 
Dr. Rosy Parmar 
Assistant Professor,  
Department of Microbiology,  
GMERS Medical College,  
Gotri, Vadodara, Gujarat 390021. 
Email: rose.p2007@yahoo.co.in  
 
Date of Submission: 29/09/2014 
Date of Acceptance: 07/11/2014 
 
How to cite this article: Thakkar CV, Desai T, Parmar R. 
Study of tension band wiring in management of fracture of 
patella in tertiary care hospital in Vadodara. J Res Med Den 
Sci 2014;2(4):63-6. 
 
Source of Support: None 
Conflict of Interest: None declared 
 
 
 


Study of tension band wiring in management of fracture of patella in tertiary care hospital in Vadodara

https://www.jrmds.in/articles/study-of-tension-band-wiring-in-management-of-fracture-of-patella-in-tertiary-care-hospital-in-vadodara.pdf

Study of tension band wiring in management of fracture of patella in tertiary care hospital in Vadodara

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals