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Abstract
The patella is an important component of the extensor mechanism of the knee. Patellar fractures are relatively uncommon injuries which need to be fixed if displacement occurs more than 2 mm. Transverse fractures comprise the largest category. Patellar fractures are intra-articular fractures which need open reduction internal fixation. Several different techniques for internal fixation have been employed which include the AO modified tension band wiring, interfragmentary screws or figure of eight wiring through cannulated screws.
The aim of this work was to evaluate the results of treatment of transverse patellar fractures with figure of eight wiring through cannulated screws.
Twenty patients were included in the study,they were admitted to El-Hadara University Hospital suffering from displaced transverse patellar fractures.
On admission all patients were assessed by history taking, clinical examination and radiological assessment.
In this study the mean age of the patients was 39.25±12.38 years. There were seventeen (85%) males and three (15%) females, twelve patients (60%) had left patellar fracture and eight (40%) right patellar fracture. The mechanism of trauma was road traffic accident in six patients (30%), falling down on a flexed knee in fourteen patients (70%). All the patients had closed fracture. The mean time lapse before surgery was 2.7±2.6 days (range from 1 to 11 days).
Treatment consisted of open reduction and holding the fracture with reduction forceps, two threaded parallel guide pins were placed within the patella, drilling was done over them, two cannulated screws were inserted over the pins and finally a stainless steel wire was passed through the screws in a figure of eight and tensioned upon the anterior surface of the patella.. Assessing the stability of fixation by flexing and extending the knee is done before closure.
A dressing and above knee back slab was applied; active exercises were started after removal of stitches after 2 weeks.
The mean time of clinical union was 9±1.72 weeks while the mean time of radiological union was 12.75±2.27 weeks.
The final results of the study as regarding the modified HSS knee scoring system included fourteen patients (70%) had excellent results (score 75 to 90 points), five (25%) good result (score 60 to 74), one (5%) fair result (score 50 to 59) and no patient had a poor result (score below 50 points).