Horizontal versus vertical orientation of the loop for tension band wiring of transverse patella fractures.

Conventional operative treatments of patella fractures are frequently associated with implant failure or displacement. Recent biomechanical studies showed that the orientation of the wire loop and the site of the wire twist can affect the fixation strength. The purpose of this study was to compare the clinical outcome of the tension band technique with loops in different orientations and different knot positions. For this retrospective study, 72 patella fractures (71 patients) were fixed with figure-of-eight configurations in combination with 2 K-wires. Patients were divided into 3 groups according to the orientation of tension band construct. A total of 40 patella fractures were placed with figure-of-eight configurations in a vertical orientation either with 1 wire twist (group 1; 16 patella fractures) or with 2 wire twists at the adjacent corners (group 2; 24 patella fractures). Thirty-two patella fractures were placed with figure-of-eight configurations in a horizontal orientation with 2 wire twists at the adjacent corners (group 3). Range of motion, complication rates, and knee scoring scales (Hospital for Special Surgery and Lysholm) were assessed during serial follow-up. Satisfactory reductions were achieved in all groups, but functional results in the early stage were different. Group 3 had better Hospital for Special Surgery and Lysholm scores at 3 months postoperatively; however, at 6 months and 1 year postoperatively, all groups had similar scores. At the 1-year follow-up, all groups achieved acceptable flexion and range of motion. The overall complication rate was lower in the horizontal group (12.5%). Placing the figure-of-eight tension band construct in a horizontal orientation can provide functional benefits in the early stage after patella fractures.