A Comparison of Braided Polyester Suture Fixation vs. Metal Tension Band Wiring in Patellar Fractures

Shah Munawar, Iqbal J, Muhammad Sufyan

ABSTRACT

Objective: To look at the outcomes of surgery comparison between two groups and to assess the risks and complications associated with each procedure.

Methods: This study performed a retrospective process of all patella fixations from 2004 – 2011. Case notes were reviewed and patients were assessed using objective and functional scores and complication rates compared.

33 patients were identified from the theatre registry. Nine patients underwent braided polyester suture fixation compared with 20 metal Tension Band Wire (TBW) fixation. Four were excluded – 3 were periosteal sleeve fractures, 1 was a revision of a metal tension band wire fixation. The mean age at the time of injury was 53.2 years of age (range 20 – 87, SD – 21), with a male to female ratio of 18:11. Mean follow-up was 29 months (range 1 – 84, SD – 29.6). 8 were lost to follow-up. 6 were deceased.

Results: Mean range of movement was comparable in both groups – mean extension was 0.7 degree in the braided polyester suture fixation group vs. 2.7 degrees in the metal TBW group (p>0.05). Mean flexion was 98.1 degrees in the braided polyester suture fixation group vs. 98.8 degrees in the metal TBW (p>0.05). Mean Knee Injury and Osteoarthritis Outcome Scores (KOOS) was 80.6 in the braided polyester suture fixation group vs. 72.6 in the metal TBW group (p>0.05).

2/9 (22%) of braided polyester suture fixations failed early – 1 primary failure, 1 secondary to trauma.

There were no early failures in the metal tension band wiring group but 45% were removed at a later date due to sequelae of prominent metalwork (p=0.03).

Conclusion: Results of braided polyester suture fixation showed that outcomes are comparable. The main advantage is that there is no soft tissue irritation in the braided polyester suture fixation group.