Cannulated screws with and without tension band wiring versus tension banding wiring alone for fixation of patella fractures: a systematic review and meta-analysis.
Systematic Review
To evaluate and compare clinical outcomes, complication rates and time to union in patients with patella fractures treated with cannulated screws (CS), cannulated screws with a tension band wire construct (CSTBW) and tension banding wiring alone (TBW)./r/nA systematic search was conducted for articles in PubMed, Medline, Embase, Cochrane CENTRAL and Cochrane database from inception to March 2024. Data pertaining to range of motion, flexion, patient reported outcome measures (PROMs), complications and time to union were extracted. Meta-analyses were performed. Odds ratios were used for dichotomous variables and the standard mean differences were used for continuous variables RESULTS: 14 studies were included. 2 compared TBW to CS, 11 TBW to CSTBW and 1 compared all three. Systematic review showed favourable results for CS compared to TBW in the domains of PROMs (measured by VAS and Lysholm Score). Meta-analyses showed favourable outcomes in a range of domains in the CSTBW group over the TBW group. These include: degree of flexion at 3 months (SMD 0.92 95% CI 0.28 to 1.56, p = 0.0048), in VAS at 3 months (SMD – 1.27, 95% CI – 1.73 to – 0.82, p < 0.001) and Lysholm score at 12 months (SMD 0.80, 95% Cl 0.21 to 1.39, p = 0.0082). Complications were observed more frequently in TBW group over the CS and CSTBW groups, leading to more frequent implant removal./r/nCannulated screw fixation with or without a tension band system was associated with better clinical outcomes and fewer complications than the traditional TBW technique for fixation of patella fractures.
