Abstract :
Introduction: Patellar fractures constitute about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous location of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. Any improper and inadequate treatment would inevitably lead to a great deal of disability which would be most perceptibly felt in a country like India, where squatting is an important activity in daily life.
Materials and Methods: This prospective study was carried out at the Department of Orthopaedics, KBNIMS, Kalaburagi. In this study, 40 patients(23 males and 17 females; mean age 42.7 years) with Patellar fractures were admitted at Khaja Banda Nawaz Institute of Medical Sciences Hospital, Kalaburagi and examined according to protocol. Associated injuries were noted. Clinical and radiological investigations were carried out to get fitness for surgery. Patients underwent Tension Band Wiring or CircumferentialWiring for the sustained fracture. Patients were followed up at 4 weeks, 8 weeks, 12 weeks till fracture union and once at 1 year after surgery using Reich and Rosenberg criteria.
Results: There was no significant difference regarding the mean age, gender, and mechanism of the fractures in patients treated by two methods of TBW and CW. 1 case of superficial infection and 3 cases of joint stiffness were noted after CW and 1 case of superficial infection and 2 cases of joint stiffness had occurred after TBW. 60% excellent, 25% good, 5% fair and 10% poor results were observed after Circumferential Wiring and 65% excellent, 15% good, 15% fair and 5% poor results after TBW. Patients
of both groups showed an appreciable and statistically significant improvement in functional outcome at 3 months follow-up period as evidenced by Reich and Rosenberg Criteria that reveals no major difference. Furthermore, the difference in improvement between the two groups was not statistically significant at 3months.
Conclusion: Our findings have shown that Circumferential Wiring and Tension Band Wiring have significantly good to excellent results in the management of fractures of patella. Depending on the categorization of fracture pattern and type, an individual operative plan is proposed.
Keyword :
Patella fracture, Tension band wiring, Circumferential wiring, Reich and Rosenberg criteria.