Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: a meta-analysis
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SYSTEMATIC REVIEW
Open Access
Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: a meta-analysis Yinwang Zhang†, Zhen Xu†, Wuxue Zhong, Fuhai Liu and Jie Tang*
Abstract Background: To compare the efficacy and safety of K-wire tension band fixation (KTB) with other alternative approaches (cannulated screws, cable pin, and ring pin) for treatment of patella fractures by performing a meta-analysis. Methods: PubMed and EMBASE databases were searched for all relevant studies. Standardized mean difference (SMD) or relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes via either a fixed- or random-effect model using Stata 13.0 software. Results: Nine literatures involving 949 patients (581 in the KTB group and 368 in the control group) were included. Pooled analysis showed there were no differences in the success rate, operative time, healing time, and number of infections between patients undergoing KTB and others. However, the incidence of complications (RR = 8.04, 95% CI = 4.45–14.53; p < 0.001) and VAS (SMD = 0.642, 95% CI = 0.22–1.06; p = 0.003) were lower, while flexion degree (SMD = − 0.70 95% CI = − 1.04–− 0.36; p < 0.001), Böstman joint function score (SMD = − 0.68, 95% CI = − 1.10–− 0.27; p = 0.001), Iowa knee score (RR = 0.88, 95% CI = 0.81–0.96; p = 0.004), and Lysholm score (SMD = − 0.71, 95% CI = − 1.10–− 0.32; p < 0.001) were significantly higher in patients undergoing alternative approaches than the KTB. Subgroup analysis also demonstrated the cannulated screw fixation was superior to KTB in reducing the incidence of complications. Conclusions: Alternative treatments may be effective for management of patella fractures and should be attempted to be popularized in clinic. Keywords: K-wire tension band fixation, Patella fractures, Cannulated screws, Cable pin, Ring pin, Meta-analysis
Introduction Patellar fractures have been a common clinical injury because of frequent traffic accidents and industrial accidents recently, with an estimated incidence of 13.1/ 100,000 per year, especially predominant in patients aged 20 and 50 years [1]. The main function of patella is to increase the force of quadriceps apparatus by improving the leverage and then maintain the extension of knee joint. Furthermore, the intact patella protects the anterior articular surface of distal femur against external violence [2]. Hereby, fractures in the patella may lead to * Correspondence: [email protected] † Yinwang Zhang and Zhen Xu contributed equally to this work. Department of Orthopedics, Shanghai Xuhui District Central Hospital, No.966, Middle Huaihai Road, Shanghai 200031, China
extension strength weakness, limited range of motion (ROM) of the knee joint, and patellofemoral or tibiofemoral arthritis, which all seriously influence the health-related quality of life of patients [3]. Therefore, how to manage patellar fractures to restore the functions of the patella has been a challenge for orthopedic surg
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