Open Reduction and Internal Fixation with Tension-Band Wiring and Cerclage for 8 Years Neglected Patellar Fracture: A Case Report


  • Agus Suarjaya Putra Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital
  • IGN Wien Aryana Consultant of Orthopaedic and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital



Neglected patellar fracture;, Cerclage; , Tension-Band Wire;


Introduction: Fractures of the patella are serious injuries commonly caused by direct trauma of the anterior knee surface. Various techniques such as tension band wiring (TBW) and cerclage wiring have been proposed.
Case: A 55-year-old woman who had a neglected left patellar fracture for 8 years. Radiographic evaluation revealed complete fracture of the left patellar bone with displacement and visible callus, fusion of the superior patellar fragment with the epi-metaphysis of the right femur with soft tissue swelling, malunion impression, left patellar subluxation anteriorly and grade III osteoarthritis. An open reduction internal fixation using tension band wire and cerclage was performed and postoperative evaluation revealed acceptable alignment of the patella and implant. Total Bostman knee was 28 points to analysis knee function.
Discussion: TBW is one of treatment methods for patella fracture fixation by counteracting muscle traction, maintaining the reduction and transforming the tensile forces between the quadriceps muscle and the anterior tibia tuberosity to
compress the patella articular cortex during knee flexion. It also stabilizes the fracture and enhances bone healing by closing the fracture gap and maintaining the interfragmentary contact. Cerclage wire is passed through the quadriceps and patellar tendon. Knee immobilization is unnecessary and the functional outcome is always adequate.
Conclusion: TBW with cerclage is favorable to stabilize a neglected transverse patella fracture. It is associated with satisfying clinical outcome and less complications. The placing of the tension band close to the patella decreases the
rate of major loss of reduction and implant failure.


Download data is not yet available.


Chang C-H, Chuang H-C, Su W-R, et al. Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment. J Orthop Surg Res 2021; 16: 365.

Gwinner C, Märdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW 2016; 5: Doc01.

Zderic I, Stoffel K, Sommer C, et al. Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury. Epub ahead of print 2017. DOI: 10.1016/j.injury.2017.05.037.

Yotsumoto T, Nishikawa U, Ryoke K, et al. Tension band fixation for treatment of patellar fracture: Novel technique using a braided polyblend sutures and ring pins. Injury. Epub ahead of print 2009. DOI: 10.1016/j.injury.2008.10.032.

Yu T, Wu Z, Mohamed SO, et al. Modified tension band wiring of patellar fracture as a technique to minimize postoperative complications: A case report. Med (United States). Epub ahead of print 2020. DOI: 10.1097/MD.0000000000019576.

Hsu KL, Chang WL, Yang CY, et al. Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures. Injury. Epub ahead of print 2017. DOI: 10.1016/j.injury.2017.10.016.

Uvaraj NR, Mayil Vahanan N, Sivaseelam A, et al. Surgical management of neglected fractures of the patella. Injury 2007; 38: 979–983.

Additional Files