Comminuted Patella Fracture and its Non-union Treated with Modified Cerclage Wiring (Wire Mesh Technique): A Case Series

1. Junior Resident, Department of Orthopaedics, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Chengalpattu, Tamil Nadu, India. 2. Professor, Department of Orthopaedics, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Chengalpattu, Tamil Nadu, India. 3. Associate Professor, Department of Orthopaedics, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Chengalpattu, Tamil Nadu, India. 4. Senior Resident, Department of Orthopaedics, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Chengalpattu, Tamil Nadu, India. 5. Assistant Professor, Department of Orthopaedics, SRM Medical College Hospital and Research Centre, Potheri, Kattankulathur, Chengalpattu, Tamil Nadu, India.

Abstract

Non-union of the patella is relatively rare, occurring in 2.4-12.5% of cases, yet it frequently requires surgical treatment due to discomfort and functional impairment. The proximal fracture fragment is usually displaced by the quadriceps, resulting in a gap that hinders recovery. Managing non-union in comminuted patella fractures is extremely challenging due to the presence of numerous tiny pieces and difficulties in attaining stable fixation. The present case series presents an innovative cerclage wiring procedure, referred to as the “Wire Mesh Technique,” employed for patients with comminuted patellar fractures and non-union. The present case series included three male patients aged 35, 42, and 66 years, each exhibiting non-union of comminuted patella fractures subsequent to trauma. All patients experienced difficulty bearing weight and extending the affected knee, characterised by extensor lag and limited range of motion. Radiographic assessments confirmed non-union of the patella in every case. After clinical and radiographic evaluation, the wire mesh procedure was utilised to address insufficient healing and the complex arrangement of fragments. Postoperative rehabilitation included early in-bed mobilisation and quadriceps exercises starting on day zero, walker-assisted non-weight bearing on day two, and gradual range of motion exercises initiated on day ten. Full weight-bearing began at two months. Postoperative imaging showed optimal implant placement and medullary healing. Patients successfully regained weight-bearing capacity and experienced enhanced knee flexibility and motion. This approach reduces circular tension and improves stability, facilitating rapid mobilisation and positive outcomes in complicated patellar fracture non-unions.

Extensor mechanism reconstruction, Internal fixation, Orthopaedic surgical technique, Postoperative rehabilitation