Functional Outcome of Modified Tension Band Wiring in Displaced Transverse Patellar Fractures: A Prospective Observational Study
DOI:
https://doi.org/10.48047/w9tx9s42Keywords:
Patella fracture, Tension band wiring, Kirschner wire, Böstman score, Functional outcomeAbstract
Background: Patellar fractures account for approximately 1% of all skeletal injuries and are a frequent cause of disruption of the extensor mechanism of the knee. Displaced transverse fractures require operative restoration of the articular surface and stability of the extensor apparatus. The modified tension band wiring (TBW) technique using two parallel Kirschner wires and a stainless-steel cerclage in a figure-of-eight configuration remains the most widely employed fixation strategy worldwide owing to its biomechanical efficiency and technical familiarity. Aim: To prospectively evaluate the radiological, clinical, and functional outcomes of modified TBW in adult patients presenting with displaced transverse patellar fractures at a tertiary-care orthopaedic centre in South India. Materials and Methods: A prospective observational study was conducted between January 2007 and December 2009 at the Department of Orthopaedics, Coimbatore Medical College and Hospital, Tamil Nadu. Thirty-eight skeletally mature patients (aged 22-58 years) with isolated, closed, displaced transverse patellar fractures (AO/OTA 34-C1.1) were treated by open reduction and modified TBW under spinal anaesthesia. A standardised postoperative protocol of antibiotic prophylaxis, immediate static quadriceps strengthening, and protected weight-bearing was followed. Functional outcome was assessed using the Böstman knee score at a minimum follow-up of six months. Results: The cohort comprised 26 men (68.42%) and 12 women (31.58%) with a mean age of 41.8 ± 9.6 years. Slip-and-fall injuries (55.26%) and road-traffic accidents (36.84%) were the leading mechanisms. Radiological union was achieved in all 38 patients within a mean of 11.4 ± 1.8 weeks. The mean Böstman score at final follow-up was 27.18 ± 2.34, with 16 excellent (42.11%), 16 good (42.11%), and 6 satisfactory (15.79%) results. Five complications (13.16%) were recorded, comprising one superficial wound infection, one persistent knee stiffness, and three symptomatic implant prominences requiring delayed removal. Conclusion: Modified tension band wiring is a safe, reproducible, and biomechanically efficient fixation method for displaced transverse patellar fractures, yielding excellent or good functional outcomes in over 84% of patients in this South Indian cohort. The technique remains the fixation of choice in resource-limited settings.
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References
Anand, K., Kant, S. and Kapoor, S.K. (1999) 'Nutritional status of adolescent school children in rural North India', Indian Pediatrics, 36(8), pp. 810–815.
Bhaskaram, P. (2002) 'Micronutrient malnutrition, infection, and immunity: an overview', Nutrition Reviews, 60(5), pp. 40–45.
Caulfield, L.E., Richard, S.A. and Black, R.E. (2004) 'Undernutrition as an underlying cause of malaria morbidity and mortality in children less than five years old', American Journal of Tropical Medicine and Hygiene, 71(2), pp. 55–63.
Dev, S.M. and Sharma, A.N. (2010) 'Food security in India: performance, challenges and policies', Oxfam India Working Papers Series, 7, pp. 1–48.
Devi, P.Y. and Geervani, P. (2010) 'Determinants of nutritional status of rural pre-school children in Andhra Pradesh, India', Food and Nutrition Bulletin, 31(4), pp. 634–640.
DLHS (2007) District Level Household and Facility Survey (DLHS-3), Tamil Nadu. Mumbai: International Institute for Population Sciences.
Gopalan, C., Rama Sastri, B.V. and Balasubramanian, S.C. (2012) Nutritive value of Indian foods. Hyderabad: National Institute of Nutrition.
Gupta, N., Shah, P., Goel, K. and Misra, A. (2013) 'Imbalanced dietary profile, anthropometry, and lipids in urban Asian Indian adolescents and young adults', Journal of the American College of Nutrition, 29(2), pp. 81–91.
ICMR (2010) Nutrient requirements and recommended dietary allowances for Indians: a report of the expert group. New Delhi: Indian Council of Medical Research.
Kapil, U. and Bhavna, A. (2002) 'Consequences of iron deficiency in young children: current issues and concerns', Indian Journal of Pediatrics, 69(2), pp. 153–157.
Kumar, R. and Barot, H. (2018) 'Prevalence of anaemia among school-age children in rural Tamil Nadu', Indian Journal of Public Health Research and Development, 9(10), pp. 345–349.
Menon, P., Ruel, M.T. and Morris, S.S. (2000) 'Socio-economic differentials in child stunting are consistently larger in urban than in rural areas', Food and Nutrition Bulletin, 21(3), pp. 282–289.
NFHS-5 (2021) National Family Health Survey (NFHS-5), India, 2019–21: Tamil Nadu. Mumbai: International Institute for Population Sciences.
Onis, M. de, Onyango, A.W., Borghi, E., Siyam, A., Nishida, C. and Siekmann, J. (2007) 'Development of a WHO growth reference for school-age children and adolescents', Bulletin of the World Health Organization, 85(9), pp. 660–667.
Pande, R.P. (2003) 'Selective gender differences in childhood nutrition and immunization in rural India: the role of siblings', Demography, 40(3), pp. 395–418.
Rajgopal, L. (2010) 'Nutritional anaemia and its management', Medical Journal of Armed Forces India,
(1), pp. 2–5.
Ramachandran, P. (2006) 'Maternal and child nutrition in India', in Krishnaswamy, K. (ed.) Diet and disease. Hyderabad: NIN, pp. 57–79.
Rani, M.A. and Mythili, S.V. (2014) 'Study on the prevalence of malnutrition and factors affecting the nutritional status among school-age children in Tiruvallur district, Tamil Nadu', International Journal of Research in Medical Sciences, 2(3), pp. 944–950.
Semba, R.D. and Bloem, M.W. (2008) Nutrition and health in developing countries. 2nd edn. Totowa, NJ: Humana Press.
Seshadri, S. (1997) 'Nutritional anaemia in South Asia', in Gillespie, S.R. (ed.) Malnutrition in South Asia: a regional profile. Kathmandu: UNICEF, pp. 75–124.
Shah, D. and Sachdev, H.P.S. (2001) 'Zinc deficiency in pregnancy and fetal outcome', Nutrition Reviews, 59(2), pp. 35–45.
Shobha, S. and Sharada, D. (2003) 'Efficacy of twice weekly iron supplementation in anaemic adolescent girls', Indian Pediatrics, 40(12), pp. 1186–1190.
Upadhyay, R.P., Chinnakali, P., Odukoya, O., Yadav, K., Sinha, S., Rizwan, S.A., Pandey, R.M. and Krishnan, A. (2012) 'High burden of anaemia among women in Tamil Nadu: an analysis of DLHS and NFHS data', ISRN Hematology, 2012, pp. 1–7.
WHO (2001) Iron deficiency anaemia: assessment, prevention, and control – a guide for programme managers. Geneva: World Health Organization.
WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization.
WHO/UNICEF/UNU (2001) Iron deficiency anaemia: assessment, prevention and control. Geneva: World Health Organization.
Zimmermann, M.B. and Hurrell, R.F. (2007) 'Nutritional iron deficiency', Lancet, 370(9586), pp. 511–520.
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