A Prospective Study of Comminuted Patellar Fractures Treated with Different Fixation Modalities: Functional Outcomes and Complications

Introduction: Comminuted patellar fractures constitute approximately 55% of all operatively managed patellar fractures and pose a persistent challenge for orthopedic surgeons. Comparative functional outcome data from India, particularly from central India, remain sparse. Objectives: The objective of the study was to evaluate and compare the functional outcomes of tension band wiring (TBW), modified TBW (MTBW), cannulated screw TBW, and modified cerclage wiring (MCW) in the surgical management of comminuted patellar fractures. Materials and Methods: This prospective observational study enrolled 63 cases of comminuted patellar fractures at Government Bundelkhand Medical College, Sagar, Madhya Pradesh, from August 2022 to April 2024. Of these, 46 underwent surgical management. Functional outcomes were assessed using the Böstman clinical grading score at 1, 3, 6, and 12 weeks post-operatively. Fisher's exact test was applied for intergroup comparisons (significance threshold: P < 0.05). Results: Mean patient age was 42.2 ± 15.4 years; 76.1% were male. Road traffic accidents were the predominant injury mechanism (69.6%). TBW was the most frequently performed procedure (43.5%). At 12 weeks, 39.1% achieved excellent and 47.9% achieved good Böstman scores. MTBW yielded the highest proportion of excellent results (56.3%). Complications occurred in 15.2% of cases, predominantly in the TBW group. No statistically significant differences were observed across modalities (P = 0.443). Conclusion: All four modalities yielded satisfactory outcomes in comminuted patellar fractures. MTBW demonstrated numerically superior excellent outcomes; MCW showed the lowest complication rate. Fixation choice should be individualized to fracture morphology and surgeon expertise.