In addition, case reports, literature reviews and letter to editors were excluded. Titles and abstracts of the studies were examined studies describing non-transverse patellar fractures were excluded from the initial result. After searching the previously mentioned databases, a search of the grey literature was conducted using Google. Keywords used for the literature search were: ‘Patella’, ‘fracture’, ‘internal fixation’, ‘tension band wiring’. During the initial search, no time limit or language restriction were applied. Methods Literature searchĪ comprehensive literature search was conducted using PubMed, ScienceDirect, Web of Science and Google Scholar on January 3, 2013. Pooling of data from selected studies was performed where appropriate. A comparison was made between fixation techniques using metal sutures or suture wire and techniques using non-metallic materials. We analysed the clinical outcome and possible complications after operation. This systematic literature assesses the available literature on the management of transverse patella fractures using metallic or non-metallic implants. 11–13 Intraosseous cellular response to biodegradable implants is considered mild, and does not influence bone union. Also, biodegradable cannulated screw fixation has been tested. Patients have been treated using K-wires and non-metallic substitutes for TBW. Recently, non-metallic and modified methods of fixation have been studied to cause less irritation and hardware failure. 7 Metal implants have to be removed as a result of local tissue irritation produced by the K-wires, 8 which can also migrate. The TBW technique is associated with failure from prominent hardware and postoperative discomfort. 3, 5 Fixation can be also achieved using TBW through cannulated screws. ![]() The classical Kirschner (K) wires and tension band wiring (TBW) technique, described by the AO foundation, 5 have been the most widely used: two parallel Kirschner wires (K-wires) are combined with figure of eight metallic TBW. 4 Fixation can be achieved in different ways. Since the patella is subjected to strong tensile forces, patella fractures require rigid fixation with anatomical reduction. About 50–80% of patellar fractures are transverse (Arbeitsgemeinschaft für Osteosynthesefragen classification: 34-C1) 1, 2 and are likely to disrupt the extensor mechanism of the knee, making operative management necessary. Patellar fracture, internal fixation, tension band wiring Introductionįractures of the patella constitute ∼1% of all skeletal fractures.
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