Functional Outcome of Displaced Transverse Patellar Fracture Treated With Tension Band Wiring: A Prospective Interventional Study

Abstract

Background: Displaced transverse fractures of the patella disrupt the extensor mechanism of the knee and usually require surgical fixation to restore articular congruity, knee function, and early mobilization. Tension band wiring (TBW) remains the standard treatment for these fractures because it converts tensile forces into compressive forces at the fracture site during knee flexion. However, functional recovery and postoperative complications continue to vary among patients.

Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Geetanjali Medical College and Hospital, Udaipur, India, between April 2024 and October 2025. Forty adult patients with displaced transverse patellar fractures underwent open reduction and internal fixation using the AO tension band wiring technique. Functional outcome was assessed using the Böstman scoring system during serial follow-up visits up to 24 weeks. Demographic characteristics, operative details, postoperative complications, and sequential improvements in pain, range of motion, stability, and overall function were analyzed using appropriate statistical methods. A p-value <0.05 was considered statistically significant.

Results: The majority of patients were 41–50 years old (72.5%), and males accounted for 60% of the study population. Road traffic accidents were the most common mechanism of injury (45%). Most procedures were completed within 70–90 minutes (82.5%). Immediate postoperative complications were uncommon, with surgical site infection and swelling each occurring in 2.5% of patients, while late complications included restricted knee motion (7.5%) and implant failure (2.5%). The mean total Böstman score was 26.63 ± 5.14. Excellent functional outcomes were achieved in 47.5% of patients, good outcomes in 37.5%, and poor outcomes in 15%, resulting in an overall satisfactory outcome rate of 85%. Significant improvements were observed in pain, range of motion, stability, and functional performance throughout the 24-week follow-up period (p<0.01).

Conclusion: Tension band wiring provides reliable fixation for displaced transverse patellar fractures, resulting in satisfactory functional recovery, low complication rates, and significant improvement in knee function. The technique remains an effective, reproducible, and cost-effective surgical option for appropriately selected patients.