title: Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures.
abstract: BACKGROUND
  Open reduction and internal fixation with tension band wire is the standard treatment for displaced transverse patellar fractures. Recently, some minimally invasive techniques have been proposed as possible alternative methods. This retrospective study compared a newly reported percutaneous osteosynthesis with conventional open method for the treatment of displaced transverse patellar fractures.
  
  
  METHODS
  The minimally invasive technique was performed by percutaneous osteosynthesis with modified Carpenter's (POMC) technique, using figure-eight wiring through two-paired cannulated screws under the control of arthroscopy and fluoroscopy. The conventional open surgery was performed with open modified anterior tension band (OMATB) technique. Totally 60 displaced transverse fractures were included in our study. Twenty were treated with percutaneous technique and 40 with open method. Outcome assessment included analysis of radiographic images, range of motion, Lysholm scores, complications, and reoperations.
  
  
  RESULTS
  Mean follow-up was 37.3 months. Comparison of POMC and OMATB groups showed statistically significant results as follows: shorter surgical time, 70.4 ± 12.5 minutes for POMC group; greater degrees of flexion, 140.4 ± 6.1 for POMC group; better total range of motion, 139.6 ± 8.2 for POMC group; higher Lysholm scores, 93.6 ± 3.1 for POMC group. Frequencies of total complications and reoperations were significantly lower in POMC group.
  
  
  CONCLUSIONS
  POMC method was a reproducibly reliable method, offering better functional outcome, lower incidence of complications, and reoperations, as compared with standard OMATB group for transverse patellar fractures. Nevertheless, it is not recommended for severely comminuted fractures.
authors.affiliation: Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taiwan, ROC. chiangcc@vghtpe.gov.tw
authors.forename: Chao-Ching
authors.initials: CC
authors.lastname: Chiang
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Jeff Lin
authors.forename: Cheng-Fong
authors.initials: CF
authors.lastname: Chen
authors.forename: Ching-Kuei
authors.initials: CK
authors.lastname: Huang
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Tzeng
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010329:Patella / Q000293:injuries*; D012086:Reoperation; D012189:Retrospective Studies