Sat., 10/6/12 Femur/Tibial Fx/Knee Injuries, PAPER #77, 9:09 am OTA-2012
Complications Following Tension Band Fixation of Patellar Fractures With Cannulated Screws Versus Kirschner Wires
C. Max Hoshino, MD1; Wesley Huy Tran, MD, JD1; John V. Tiberi, MD1;
Mary Helen Black, PhD2; Bonnie H. Li, MS2; Stuart M. Gold, MD1; Ronald A. Navarro, MD;2
1Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, California, USA;
2Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center,
Harbor City, California, USA
Purpose: Displaced patellar fractures are commonly stabilized with a modified anterior tension band construct. The goal of the current study is to compare the incidence of complications after tension band fixation of the patella with Kirschner wires (K-wires) versus screws.
Methods: We performed a retrospective cohort study of consecutive operatively treated patella fractures. Patients were divided into two cohorts: fractures fixed using K-wires and fractures fixed using screws. The primary outcome measure was revision surgery for early loss of fixation. Secondary outcomes that were evaluated include postoperative infection and the need for hardware removal due to hardware irritation.
Results: 448 patellar fractures were studied. K-wires were used to fix 315 (70%), and screws were used to fix 133 (30%). The incidence of fixation failure was 3.5% in the K-wire group and 7.5% in the screw group (P = 0.065). A postoperative infection occurred in 4.4% of patients in the K-wire group and 1.5% of patients in the screw group (P = 0.17). 116 patients (37%) in the K-wire group and 30 (23%) in the screw group underwent elective hardware removal (P = 0.003). After adjusting for confounding variables, a trend toward increased incidence of fixation failure with screws compared to K-wires was still present (P = 0.083). Patients treated with K-wires were twice as likely to undergo hardware removal compared to those treated with screws (P = 0.002). The median follow-up was 2.8 years in the K-wire group and 2.5 years in the screw group.
Conclusion: Serious complications are rare following treatment of patellar fractures with modified tension band using either K-wires or cannulated screws. In both groups the rate of fixation failure was low, but a trend was present toward fewer fixation failures with K-wires compared to screws. With contemporary perioperative measures, the rate of postoperative infection was low. Symptomatic hardware, the most common complication observed, was twice as frequent in patients treated with K-wires. These findings provide a foundation for future prospective, randomized studies, to confirm the observations.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.